Common and Uncommon Presentation of Fluid within the Scrotal Spaces

Abstract

Ultrasonography(US) of the scrotum has been demonstrated to be useful in the diagnosis of fluid in the scrotal sac. Grayscale US characterizes the lesions as testicular or extratesticular and, with color Doppler, power Doppler and pulse Doppler, any perfusion can also be assessed. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. The paper reviews the current knowledge of ultrasound in conditions with fluid in the testis and scrotum. The review presents the applications of ultrasonography in the diagnosis of hydrocele, testicular cysts, epididymal cysts, spermatoceles, tubular ectasia, hernia and hematoceles. The aim of this paper is to provide a pictorial review of the common and uncommon presentation of fluid within the scrotal spaces.

Keywords: US; fluid; scrotum; testis; ultrasonography.

Figures

Fig. 1

a Normal closure of processus vaginalis. Straight arrows indicate funicular process and curved arrow indicates tunica vaginalis. b Communicating hydrocele – complete patency of tunica vaginalis. c Funicular hydrocele of the cord – diverticulum communicates with the cord only. d Encysted hydrocele of the cord – no communication to peritoneum or tunica vaginalis.

Fig. 2

Antenatal hydrocele shows the fluid in the scrotal sac with echogenic testis.

Fig. 3

An ovoid anechoic mass is seen in the groin along the spermatic cord – spermatic cord hydrocele.

Fig. 4

Hydrocele noted with testicular appendage is well defined.

Fig. 5

Chronic hydrocele showing fluid having multiple thin septations in the scrotal sac.

Fig. 6

An increase in the resistive index (RI) of the testicular artery is seen due to a compressive effect on the vessels.

Fig. 7

Low-level echoes seen in the scrotal fluid collection indicative of hematocele.

Fig. 8

A pyocele appearing as a septated fluid collection with complex heterogeneous fluid.

Fig. 9

Simple cyst showing an intratesticular anechoic center and through-transmission without a perceptible wall.

Fig. 10

Cystic dilatation adjacent to the mediastinum testis indicative of tubular ectasia of rete testis.

Fig. 11

Multiple anechoic, serpiginous, tubular structures of varying sizes. Color Doppler US demonstrates the venous flow pattern that increases during a Valsalva maneuver.

Fig. 12

Shaggy irregular walls noted in an intratesticular lesion that shows low-level internal echoes.

Fig. 13

Well defined cyst in the head of epididymis in a case of epididymal cyst.

Fig. 14

Cystic lesion in the epididymal head that contains internal echoes showing a fluid-fluid level.

Fig. 15

Large lesion in the head of epididymis with internal echoes within a cystic lesion with no vascularity within mimicking a mass lesion.

Fig. 16

Identification of loops of bowel noted within the scrotum with minimal fluid around it in inguinoscrotal hernia.