Advances in sonographic technology have vastly improved the diagnostic capability of scrotal sonography. The addition and refinement of color Doppler has allowed achieving more information about both morphology and perfusion, moreover also the knowledge of sono- anatomy is a crucial factor for an accurate interpretation of scrotal pathology.
The aim of this presentation is to report about sonographic findings of more than 140 observed pediatric patients with different scrotal pathology. The children with an undescendent testis are excluded from this study.
The scrotal disorders range from non-acute and benign (congenital or acquired abnormalities to more acute conditions).
This patient material is divided in 2 groups. The first group includes patients with an acute or urgent condition such as, testicular torsion (21), epididymitis (24), malignant tumor (testicular or paratesticular neoplasms (31)) traumatic or non-traumatic hematoma (12). The second group are children with non-acute abnormalities containing hydrocele (26), varicocele (4), different type of cysts (10) and others.
The sonographic appearance of each scrotal disorder is characteristic and specific, in acute conditions such as testicular torsion classical signs are hetero-echogenicity, absence of perfusion, reactive hydrocele and scrotal wall-thickening. The enlargement and hyperemia of epididymis with normal vasculated testis are typical findings by epididymitis, in both conditions the clinical signs are similar to scrotal thickening.
Sonographic differentiation of testicular tumor is more difficult. Usually malignant tumors reveal frequently hetero-echogenicity with infiltration into the surrounding structures. Intertestinal adrenal mass is a frequent finding in patients with adrenogenital syndrome, this as a hypo-echogenic mass mimicking a tumor.
In Conclusion sonography is an invaluable modality for assessing the scrotal pathology. Color Doppler is highly reliable as additional procedure should be used routinely to look for vascularity and perfusion of affected testis and its surrounding structures.