The scrotum Scrotum A cutaneous pouch of skin containing the testicles and spermatic cords. Testicles: Anatomy is a sac hanging outside the body that contains parts of the male reproductive system. The scrotum Scrotum A cutaneous pouch of skin containing the testicles and spermatic cords. Testicles: Anatomy’s main function is to support testicles Testicles The testicles, also known as the testes or the male gonads, are a pair of egg-shaped glands suspended within the scrotum. The testicles have multiple layers: an outer tunica vaginalis, an intermediate tunica albuginea, and an innermost tunica vasculosa. The testicles are composed of testicular lobules and seminiferous tubules. Testicles: Anatomy outside the body so that spermatogenesis Spermatogenesis The process of germ cell development in the male from the primordial germ cells, through spermatogonia; spermatocytes; spermatids; to the mature haploid spermatozoa. Gametogenesis can be completed under optimal conditions. The scrotum Scrotum A cutaneous pouch of skin containing the testicles and spermatic cords. Testicles: Anatomy can be affected by various pathologic conditions, and imaging is a valuable tool in reaching the appropriate diagnosis. The most important imaging method is ultrasonography +/– Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) mode because scrotal structures are superficial with no intervening gas. MRI is useful when ultrasound is indeterminate.
Last updated: 3 Sep, 2021
Ultrasonography is often the best imaging method for the scrotum Scrotum A cutaneous pouch of skin containing the testicles and spermatic cords. Testicles: Anatomy.
Scrotal ultrasonogram showing the testicle (with a homogeneous Homogeneous Imaging of the Spleen echotexture with no focal lesions or surrounding fluid) and the epididymis Epididymis The convoluted cordlike structure attached to the posterior of the testis. Epididymis consists of the head (caput), the body (corpus), and the tail (cauda). A network of ducts leaving the testis joins into a common epididymal tubule proper which provides the transport, storage, and maturation of spermatozoa. Testicles: Anatomy
Image by Hetal Verma, MD.Doppler ultrasound showing normal arterial and venous flow with normal venous (left image) and arterial (right image) waveforms
Image by Hetal Verma, MD.Ultrasound findings include:
Epididymo-
orchitis
Orchitis
Inflammation of a testis. It has many features of epididymitis, such as swollen scrotum; pain; pyuria; and fever. It is usually related to infections in the urinary tract, which likely spread to the epididymis and then the testis through either the vas deferens or the lymphatics of the spermatic cord.
Epididymitis and Orchitis in a 45-year-old man presenting with painful
swelling
Swelling
Inflammation of the right hemiscrotum for 3 days:
a: Transverse ultrasonogram of the
scrotum
Scrotum
A cutaneous pouch of skin containing the testicles and spermatic cords.
Testicles: Anatomy shows an enlarged
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) right testis (RT) and a normal left testis (LT). The overlying right scrotal
skin
Skin
The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.
Skin: Structure and Functions is thickened (asterisk).
b: Longitudinal color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) ultrasonogram of the right hemiscrotum shows increased vascular
flow
Flow
Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls.
Vascular Resistance, Flow, and Mean Arterial Pressure in the right
epididymis
Epididymis
The convoluted cordlike structure attached to the posterior of the testis. Epididymis consists of the head (caput), the body (corpus), and the tail (cauda). A network of ducts leaving the testis joins into a common epididymal tubule proper which provides the transport, storage, and maturation of spermatozoa.
Testicles: Anatomy and testis.
Orchitis
Orchitis
Inflammation of a testis. It has many features of epididymitis, such as swollen scrotum; pain; pyuria; and fever. It is usually related to infections in the urinary tract, which likely spread to the epididymis and then the testis through either the vas deferens or the lymphatics of the spermatic cord.
Epididymitis and Orchitis:
Color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) shows increased
flow
Flow
Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls.
Vascular Resistance, Flow, and Mean Arterial Pressure in the left testis (arrow) with normal color
flow
Flow
Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls.
Vascular Resistance, Flow, and Mean Arterial Pressure in the right testis.
Tuberculous epididymo-
orchitis
Orchitis
Inflammation of a testis. It has many features of epididymitis, such as swollen scrotum; pain; pyuria; and fever. It is usually related to infections in the urinary tract, which likely spread to the epididymis and then the testis through either the vas deferens or the lymphatics of the spermatic cord.
Epididymitis and Orchitis in a 39-year-old man with a history of pulmonary
tuberculosis
Tuberculosis
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes.
Tuberculosis, presenting with chronic painless left testicular
swelling
Swelling
Inflammation for 3 years:
Composite ultrasonogram of the left hemiscrotum show a nodular, enlarged heterogeneously
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) epididymal head (HE) and tail (TE), and heterogeneously echoic testis (T).
Ultrasound findings include:
Bilateral
hydrocele
Hydrocele
Accumulation of serous fluid between the layers of membrane (tunica vaginalis) covering the testis in the scrotum.
Varicocele, Hydrocele, and Spermatocele in a 58-year-old man with a history of progressive painless
swelling
Swelling
Inflammation of bilateral hemiscrotum for 2 years:
Oblique color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) images show
anechoic
Anechoic
A structure that produces no echo at all (looks completely black)
Ultrasound (Sonography) fluid surrounding the
testes
Testes
Gonadal Hormones, left more than right. There is normal vascular
flow
Flow
Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls.
Vascular Resistance, Flow, and Mean Arterial Pressure in both the right (RT) and left (LT)
testes
Testes
Gonadal Hormones.
Metastatic testicular
tumor
Tumor
Inflammation presenting as a scrotal
hydrocele
Hydrocele
Accumulation of serous fluid between the layers of membrane (tunica vaginalis) covering the testis in the scrotum.
Varicocele, Hydrocele, and Spermatocele:
Scrotal ultrasonography findings showing (A) a large amount of fluid in the left scrotal sac and (B) a small amount of fluid with internal echogenic material in the right scrotal sac, indicating bilateral hydroceles
Ultrasound findings include:
Varicoceles color Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) shows a venous pattern of color flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure in the anechoic Anechoic A structure that produces no echo at all (looks completely black) Ultrasound (Sonography) channels Channels The Cell: Cell Membrane (asterisk) confirming the diagnosis of both intratesticular and extratesticular varicoceles.
Image: “Varicoceles Color Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography)” by Patiala B. License: CC BY 2.0Color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) ultrasound image:
Variceal gonadal vein in the left
inguinal canal
Inguinal canal
The tunnel in the lower anterior abdominal wall through which the spermatic cord, in the male; round ligament, in the female; nerves; and vessels pass. Its internal end is at the deep inguinal ring and its external end is at the superficial inguinal ring.
Inguinal Canal: Anatomy and Hernias
Ultrasound findings:
Gray-
scale
Scale
Dermatologic Examination and color
Doppler
Doppler
Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.
Ultrasound (Sonography) of
testicular torsion
Testicular torsion
Testicular torsion is the sudden rotation of the testicle, specifically the spermatic cord, around its axis in the inguinal canal or below. The acute rotation results in compromised blood flow to and from the testicle, which puts the testicle at risk for necrosis.
Testicular Torsion:
In the early phases of torsion (1–3 hours), testicular echogenicity appears normal. With progression, enlargement of the affected testis and increased or heterogeneous echogenicity are common findings.
Ultrasound findings include:
Leydig cell
tumor
Tumor
Inflammation:
Heterogeneous
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast in which
malignancy
Malignancy
Hemothorax was suspected, eventually found to be Leydig cell
tumor
Tumor
Inflammation with similar size estimated preoperatively
Structure | T1-weighted | T2-weighted | With contrast |
---|---|---|---|
Testicle ( homogeneous Homogeneous Imaging of the Spleen oval structure) | Hypointense Hypointense Magnetic Resonance Imaging (MRI) to isointense | Hyperintense Hyperintense Magnetic Resonance Imaging (MRI) | Enhance |
Epididymis Epididymis The convoluted cordlike structure attached to the posterior of the testis. Epididymis consists of the head (caput), the body (corpus), and the tail (cauda). A network of ducts leaving the testis joins into a common epididymal tubule proper which provides the transport, storage, and maturation of spermatozoa. Testicles: Anatomy | Isointense | Hypointense Hypointense Magnetic Resonance Imaging (MRI) | Enhance |
Tunica albuginea Tunica albuginea Penis: Anatomy | Hypointense Hypointense Magnetic Resonance Imaging (MRI) | Hypointense Hypointense Magnetic Resonance Imaging (MRI) | Not applicable |
MRI findings include:
Transverse T1-weighted image depicts a multilobular left scrotal
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast (short arrow), located in the paratesticular space.
The lesion had similar signal intensity when compared with the normal testicular parenchyma (asterisk).
Left
hydrocele
Hydrocele
Accumulation of serous fluid between the layers of membrane (tunica vaginalis) covering the testis in the scrotum.
Varicocele, Hydrocele, and Spermatocele (long arrow)