Scrotal Imaging - Torsion and Testicular Carcinoma

00:01 So let's take a look at this case.

00:02 We have 4 ultrasound images of the scrotum here.

00:05 Let's take a look at each one of these individually.

00:08 So this is a normal ultrasound image without Doppler.

00:11 Just take a look at the echo texture of the testicle and compare it with the previous normal ones that we take a look at.

00:17 This a Doppler evaluation.

00:18 So a color Doppler evaluation of the left testicle.

00:22 Again you can see actually very little flow.

00:24 We have just a little blip of flow over in the corner here but there's really no other flow to that testicle.

00:28 This a spectral evaluation of the same testicle so you can see here there actually is no spectral wave form identified.

00:35 So not only is there no color, there's also no spectral wave form identified and then here is the comparison of the two testicles side by side.

00:41 So this is an example of the normal right testicle and then here we have the abnormal left testicle.

00:48 So the images demonstrate a slightly heterogeneous hypoechoic testicle which has no color, or spectral flow in Doppler evaluation.

00:55 And this is an example of testicular torsion.

00:58 In this patient the testicle looks like it is still salvageable.

01:01 It doesn't look like it's shrunken in size.

01:02 And although it's slightly hypoechoic, it's not significantly hypoechoic.

01:06 So this is a patient that immediately needs surgical detorsion.

01:10 So when we see testicular torsion on ultrasound, the next step is to call urology immediately for detorsion.

01:16 This is a surgical emergency.

01:18 And there is an 80 to a hundred percent chance of salvage if the testicle is detorsed within 6 hours.

01:24 There's really no chance of salvage unfortunately, if it has already been 24 hours.

01:28 It's important to remember that normal ultrasound does not exclude early or partial torsion.

01:33 Early torsion may have no ultrasound findings and partial torsion which is a testicle that torses and detorses may also not have any findings if you're catching it at a phase in which it is in its normal position.

01:45 So if we do have a clinical suspicion of torsion that we don't see on the ultrasound, it's important to remember to repeat that ultrasound within 4 hours.

01:52 So let's discuss testicular carcinoma.

01:55 Any solid mass that's within the testicle should raise a suspicion for carcinoma.

02:00 The first line of imaging in a patient that presents with the palpable mass is an ultrasound. So let's take a look at these ultrasound images.

02:08 These are both ultrasound images of the right testicle.

02:11 You can see here that this is a non-Doppler standard ultrasound image and then image on the right is a Doppler image which does show some color flow to the testicle.

02:21 Again compare these with some of the normal ones that we saw previously.

02:32 The testicle appears very heterogeneous.

02:34 There's a heterogeneous solid mass within it that has increased blood flow.

02:38 Testicular cancers can often metastasize to the para-aortic lymph nodes.

02:42 So whenever we see a testicular mass, the next step should always be to do a CT of the abdomen and pelvis to look for staging, to look for abnormal lymph nodes.

02:50 Lung metastases are also very common so a chest x-ray is usually done in conjunction.

02:55 This is an example of a patient that actually did have metastatic testicular carcinoma.

02:59 So this is a coronal CT image of the abdomen and you can see here, this is the normal aorta.

03:05 And then adjacent to it you see this small soft tissue densities which represent enlarged para-aortic lymph nodes and this is a common location for a testicular cancer to metastasize.