Scrotal Ultrasound is a diagnostic study that allows you to assess the size, structure of the testicles and appendages, the structure of the scrotum wall, the volume of fluid produced by the testicles and prostate gland. The technique is shown in the framework of the diagnosis of infertility, erectile dysfunction, disorders of sexual development and testicular neoplasms. There are two examination options: scrotal ultrasound (isolated) and scrotal ultrasound with Doppler examination of the vessels.
Scrotal ultrasound organs is performed without special training. Before the study, daily hygiene procedures should be carried out. Fear, fright, pain and stress can cause the testicles to be drawn into the inguinal canal, so the child needs to be emotionally prepared for the upcoming manipulations: tell about their safety, importance for health. If there is soreness of the scrotum, it is necessary to warn the doctor about this, then before scanning he will apply means of surface anesthesia.
With scrotal ultrasound, the testicles and appendages of the testicles are visualized, their number, size, structure and contours; the volume of free fluid is estimated; the presence of neoplasms and traumatic lesions is revealed. With a comprehensive ultrasound examination of the scrotum and blood vessels, along with the above characteristics, the state of local blood flow, integrity and patency of superficial and deep vessels are studied, aneurysms, thrombi, emboli, thromboembolism and atherosclerotic plaques are diagnosed.
Normally, in the ultrasound image, the testicles are paired rounded formations with a smooth surface. They have moderate echogenicity with a fine-grained structure, consist of several layers differing in density and thickness. The appendages of the testicles are wedge-shaped formations structurally similar to the testicles. A certain amount of homogeneous liquid can be determined. With the help of ultrasound diagnostics , the following pathologies are detected:
- Cryptorchidism. Ultrasound diagnostic devices allow visualizing testicles with a diameter of more than 10 mm. In cryptorchidism, they can be found in the inguinal canal. In every tenth patient with cryptorchidism, one testicle remains in the abdominal cavity and is not determined by ultrasound. Dopplerography confirms the insufficiency or absence of testicular blood flow.
- Violation of puberty. Ultrasound is used to diagnose delayed or early puberty. At puberty, the echo density of the testicles increases, becomes like in adults (in children it is lower). This usually happens by the age of 15-17. Another sign of puberty is the mediastinum of the testicle, which is displayed as a band of high echogenicity in the sagittal plane.
- Neoplasms of the testicles. The heterogeneity of the echostructure of the glands is determined. Tumors are represented by areas of altered echogenicity: lymphomas, seminomas – reduced; chorionepitheliomas, embryonic carcinomas, teratomas – increased. In case of decay, internal cyst or hemorrhage, the fluid inside the neoplasia is visualized.
- Egg concretions. They are formed with Klinefelter syndrome, cryptorchidism, after chemotherapy. On the monitor of the ultrasound device, calcinates are represented by echopositive inclusions of high density.
- Orchit. The inflammatory process is provoked by an infection or injury. In the ultrasound picture, the size of the testicle is significantly increased, the homogeneous internal structure is preserved, but with edema, a homogeneous decrease in echogenicity is characteristic. According to Dopplerography, increased blood flow is detected, and in the chronic form of orchitis – a decrease.
- Epididymitis. Acute inflammatory processes in the appendage of the testicle occur during infection. On the first day, the testicular tissues are not changed, only the size of the appendage increases. Later, signs of orchitis are diagnosed. Dopplerography confirms diffuse and local increased blood supply in the testicle and appendage.
- Varicocele. Varicose veins of the spermatic cord develop with scars, tumors and anomalies of the location of blood vessels. According to the results of ultrasound Dopplerography, changes in the structure and tone of veins, uneven blood flow with stagnation and pathological blood discharge are diagnosed.
- Twist the testicles. Twisting occurs after injuries, against the background of stress and sexual arousal. The tissues of the genital glands are heterogeneous, chaotically alternating areas of different echogenicity. Dopplerographic signs are a sharp impoverishment, absence or reactive acceleration of blood flow in the testicles.
Scrotal ultrasound is performed as part of a comprehensive examination of the patient. The results are interpreted taking into account the data of the patient’s survey, examination and laboratory tests. The presumed diagnosis is confirmed after receiving complete information about the state of the scrotum organs.
Scanning the scrotum with ultrasound waves does not have a negative effect on the body, does not affect erectile and reproductive function. At the same time, the study provides up-to-date information about the structure and functioning of appendages and testicles, allows diagnosing diseases at early preclinical stages, and monitoring the effectiveness of treatment. Despite the safety and accessibility of ultrasound, the informative value of its data is limited. For example, to clarify the nature of the neoplasm, additional MRI, biopsy and histological examination of tissues are required.