Interpretation of ultrasound of the scrotum. Ultrasound of the organs and vessels of the scrotum: norms, explanation, how to do a Doppler study. Frequent pathological changes

To study the organs located in the scrotum area, an ultrasound scan of the vessels of the testicles is prescribed. This safe method, which eliminates radiation and invasiveness. This procedure assesses the speed and direction of blood flow, the presence of blood clots, pathologies, the state of the lumen of blood vessels and refers to an additional method for studying the male genital organ.

Characteristics of the method

Ultrasound of the scrotum with Doppler ultrasound is based on the Doppler principle. This study measures sound wave, the signal frequency is determined and mathematical processing is performed. Doppler ultrasound evaluates the condition of blood vessels, determines the presence of pathologies of organs located in the scrotum, and what capacity the vessels have. Often, to get a complete picture, blood flow is measured during an erection.

Ultrasound machine, which is equipped with a Doppler, has the following types:

Color flow is based on the color display of blood flow. The most commonly used colors are red and blue.
ED allows you to evaluate the picture of what is happening due to color shades, their brightness, and intensity.
The ID estimates blood flow velocity using an acoustic signal.

When shown

Doppler ultrasound with Doppler is used if there is a suspicion of a benign or malignant formation. However, there are other indications for research: varicocele, testicular torsion, damage resulting from trauma or blows. For these pathologies, ultrasound not only evaluates blood flow, but also helps to identify the causes that provoked them.

Often, a child is examined in the presence of an acute stage of the disease. It is the only way, providing maximum information and allowing the determination of a therapeutic regimen.

pain in the scrotum, swelling, which indicate the presence inflammatory process;
enlarged scrotum, which indicates the presence of an infectious disease, hernia, hydrocele;
tumor process, palpable and visible with ordinary eyes;
infertility;
obstruction of the connecting canal;
injuries;
undescended testicle.

If during an ultrasound examination the doctor does not receive the necessary information, the patient may be prescribed an additional examination, for example a color examination with Doppler

What does it show

Many men are interested in the question of what an ultrasound of the scrotum shows. When conducting this survey, the following data is obtained:

how many testicles are in the scrotum;
how are the testicles located?
is there liquid in the shells and what is its quantity;
testicle shapes;
echostructure of the area under study;
appendage sizes;
blood flow condition.

U healthy person The testicles should be in the scrotum. However, the following phenomena also occur: one or two testicles not descended into the scrotum, the location of the testicle near the base of the genital organ, on the femur, pubis, testicular torsion, which is characterized by the presence of the upper pole in the lower part, the location of the epididymis in front of the testicle. Its normal location is behind the organ.

Carrying out the procedure

For ultrasound diagnostics no special preparatory measures are required. The study can be carried out at any time. Preparing for an ultrasound states that three days before the diagnosis you need to exclude the use of any alcoholic drinks, per day – coffee, strong tea, medicines that have an effect on blood pressure. In addition, it is important to carry out hygienic treatment of the genital organ and not take liquid for 3 hours. It is recommended to visit the toilet half an hour before the procedure.

During the procedure, the doctor moves an ultrasonic sensor over the area being examined.

This procedure is completely painless and takes place within 20 minutes. During the study, the patient lies on the couch on his back or side, freeing the lower part of his body from clothing. You may also need to change your body position; the examination may be performed while standing. A conductive gel is applied to the test area. electromagnetic waves. During an ultrasound, the following pelvic organs are diagnosed:

testicles;
prostate;
seminal vesicles;
penis;
scrotum;
vas deferens;
prostate gland.

Norm

The interpretation of the ultrasound first of all shows the shape of the testicles. A healthy man's testicles are round or oval in shape. The testicles can be presented with a modified shape, which can be elongated, enlarged on one side. If the ultrasound norm is rejected, then this may be a sign of an inflammatory process, cancer, injuries. Contour and size indicators are also important.

Increased size and altered contour may indicate oncology, torsion, orchitis. A decrease in size indicates atrophy, hypoplasia, or malnutrition. Violation of the echostructure is a sign of cystosis, abscess, hematoma. These pathologies are characterized by heterogeneity of echostructure. The following are considered normal indicators for a man:

testicles from 3 to 5 cm long, from 2 to 3 cm wide, with a homogeneous echostructure, without the presence of formations, with smooth and clear edges;
appendages - the size of the head is not less than 10 mm, the tail and body should not be visible, without the presence of formations, with a homogeneous echostructure;
scrotum – thickness no more than 8 mm, without formations, with a homogeneous echostructure;
free fluid should be present in a volume of 1 to 2 mm, with a homogeneous echostructure.

Diagnosis of pathology is carried out both in childhood and in adulthood

Doppler also allows you to analyze the following indicators:

structures of the cavernous bodies, which should have a diameter of 3 to 5 mm with a homogeneous echostructure, without the presence of inclusions;
the onset of erection should have a maximum speed of 35 cm per second / 8 cm per second. Young patients may have readings of 100 cm in s. / 20 cm in s. In this case, the diameter of the corpus cavernosum increases to 10 mm;
During the rigid phase, speeds decrease. However, the peak speed should not be lower than 30 cm/s. A smaller number indicates erectile dysfunction;
the difference in the size of the corpus cavernosum from erection to rest should be above 60%;
the resistance index rate should be more than 0.85; pulsation – 4.

Common pathologies

Most often, ultrasound is used to diagnose the following pathologies. Testicular torsion, which is related to injuries resulting from overexertion of the abdominal muscles. This pathology is accompanied by swelling, painful sensations, often occurs in young boys.

Spermatocellus is characterized by enlargement of the testicles, which causes discomfort, pressure that increases while walking, or any change in position. This condition can cause a cyst and lead to its rupture. Ultrasound of the vessels of the scrotum can reveal impaired blood flow, shows narrowed vessels, and injuries. Thereby facilitating early initiation of therapy.

A scrotal ultrasound is a procedure that examines the scrotum using high-frequency ultrasound waves to see its internal structure. This method refers to the primary diagnostic measure that helps identify the presence of pathologies in men’s health.No need to talk about the importance early detection diseases, since our health and life expectancy directly depend on this.

What are the indications for the study?

Ultrasound of the scrotum is prescribed in the following cases:

male infertility
an increase in the size of the epididymis and testicle
erectile dysfunction (inability to achieve an erection)
pain in the scrotum and swelling
suspicions of inflammatory diseases testicles and scrotum (orchitis, epididymitis, orchiepididmitis)
organ injury (hemorrhage, hematoma, tissue damage)
the appearance of tumor-like formations in the testicle and outside it
a decrease in one or both testicles in size, which is accompanied by sagging of the scrotum on one or both sides, respectively
puberty ahead of schedule, or, conversely, the presence of signs of its slowdown
change in spermogram readings
increase lymph nodes which may indicate the presence of a malignant tumor in the testicles
suspicion of varicicol
surveillance of previously detected tumors, infections and leukemias
Cryptorchidism is an anomaly of the testicles, characterized by their absence (one or both at once) or non-standard position in groin area
endocrine diseases
suspicion of an inguinal hernia with partial entry into the scrotum
monitoring the condition of the organ after operations performed on it.

If it is necessary to assess the condition of the scrotum and blood flow parameters in it, vascular bridle scrotum The procedure allows us to identify the true factors that caused many diseases (for example, varicocele).

It is also possible to accurately determine the presence of testicular torsion. With a conventional ultrasound, this pathology is not detected accurately. Dopplerography of the scrotum is a completely accessible and informative study.

Do you need any preparation for this procedure?

No special preparation is required for scrotal ultrasound. The only condition for performing this study is hygienic treatment of the genital organ.

Sequence of the study

How to do an ultrasound of the scrotum:

the patient lies on the couch, on his back or on his side
A special gel is applied to the scrotum area, which helps to establish safe contact between the patient’s skin and the ultrasound machine.
The scrotum is examined using an electromagnetic sensor.

What ultrasound indicators are normal?

In the absence of pathologies, the following examination criteria and characteristics must be present in the protocol of this study:

Testicles:

are determined
size: for an adult man it should be 3-5 cm in length, 2-3 cm in width
contours: smooth, clear
presence of additional formations: not detected.

Appendages:

head size: no more than 10-15 mm
tail and body: not visible
echostructure: homogeneous, isoechoic
contours: clear, even
the presence of additional formations was not detected.

Free liquid:

homogeneous
the amount is within normal limits (1-2 ml).

Scrotum:

wall thickness no more than 8 mm.

Interpretation of the study for pathologies

Ultrasound results of the scrotum in the presence of various diseases:

Epididymitis:

an increase in the size of the head of the epididymis with a change in its structure
the tail and body of the appendage may be visible
the presence of fluid in the scrotum is possible (a similar pathology can be observed with: hydrocele, lymphocele, hematocele).

Abcess of the appendage:

the presence of a space-occupying formation with uneven contours and reduced echogenicity
pockets of rarefaction with the same uneven edges are visible.

Closed injury:

uneven contours of the testicles and their irregular shape
heterogeneity of echostructure
presence of liquid at the site of damage.

Adnexal cyst:

the presence of a clear round formation, inside of which liquid is visible
the septum in the cyst is visible.

Testicular tumor:

irregular shape
the presence of voluminous formations of increased or decreased echo density, both in the testicle itself and beyond it
increased volume of fluid in the scrotum.

Infertility:

epididymal cysts are detected and spermatic cord, compressing the vas deferens.

Are there any risks from performing an ultrasound?

The ultrasound waves used for the procedure are not radiation, therefore There is no harm caused by this research.

For urological problems, ultrasound of the scrotal organs is often prescribed. The scrotum is a musculocutaneous sac-like formation in men, which includes organs such as the testicles, spermatic cords and epididymis. The organs are located in such a way that they can only be examined using an ultrasound examination.

The ultrasound examination procedure allows for a high-quality and informative diagnosis and assessment of the condition of the male reproductive organs.

Advantages of this procedure

Using ultrasound, the male genital organs are scanned and assessed internal state. Ultrasound has its advantages:

An absolutely safe method that does not irradiate the body. The result is very informative and accurate;
using Doppler ultrasound, you can assess not only the condition of the organs located in the scrotum, but also view the circulatory system;
a contact method of examination that does not cause discomfort or pain.

With all the many advantages, there are also some disadvantages. It is difficult to diagnose a malignant tumor using ultrasound. Even if a tumor has been identified, there is no way to determine its nature - benign or malignant. Therefore, performing an ultrasound examination is the primary procedure for examining the genital organs. If necessary, the urologist may prescribe additional examinations in addition to ultrasound.

Indications for use

Usually, an ultrasound is prescribed by a urologist. Additionally, there may be ultrasonography with Doppler to determine the condition of blood vessels of this body. Indications for examination:

carried out to monitor the organ after operations;
with a diagnosis of “male infertility”;
the risk of the hernia spreading to the groin area;
with enlargement of the testicles and their appendages;
the presence of diseases of the endocrine system;
lack of erection;
if the patient does not have one or both testicles;
the appearance of pain in the scrotum and its swelling;
in the presence of tumors or chronic diseases;
suspicion of inflammatory processes;
suspicion of the appearance of varicose veins of the testicle or spermatic cord (varicocele);
after suffering an injury;
sometimes an examination is carried out for enlarged lymph nodes;
if tumors appear on the scrotum;
examination is carried out in adolescence to determine early or late puberty;
poor sperm count.

Carrying out the procedure

Photo ultrasound image of the scrotum - testicles

Before performing the examination procedure on the scrotal organs, no special preparation is needed.

The study is performed in a lying position. A conductive contact gel is applied to the desired area for examination. It is advisable that the gel is not cold, otherwise the testicles may retract from the cold. abdominal cavity, which will not allow the examination to be carried out as needed.

If pain occurs in the area of the scrotal organs upon contact with the sensors (in the case of tumors of unknown etiology), then perform local anesthesia.

First, the condition and structure of one testicle is examined, then the second.

When performing an ultrasound with Doppler, the venous plexuses and the condition of the vessels in the groin area are carefully checked.

The ultrasound examination procedure itself is performed within 15 minutes, in some cases, for example, when visualization of organs is difficult, it can last up to half an hour.

Ultrasound with Doppler ultrasound

This procedure is aimed at studying the vessels, veins, capillaries and blood flow, its direction in the groin area and its organs. Using Doppler you can evaluate:

level of enrichment of the scrotal organs with blood;
assessment of the rate of blood supply, the volume of blood supplied;
condition of blood vessels, their structure and walls.

Dopplerography of the vessels of the groin area does not require special preparation.

Doppler examination allows the doctor to identify the most weak spots vascular bed in the groin area and prescribe appropriate treatment.

What diseases can be detected by ultrasound

During an ultrasound of the testicles, the doctor can make a preliminary diagnosis, which can later be confirmed after additional examinations and tests. During an ultrasound examination, the following pathologies can be preliminarily diagnosed:

Testicular cysts. They are single, unilateral small neoplasms, usually detected by a sonologist in the middle of the gonad. Testicular cysts can be congenital or acquired (neoplasms of the epididymis), the latter often simulating hydrocele.
Congenital dropsy (hydrocele) of one or both testicles.
An ultrasound scan of the scrotum may reveal tumors.
If a child is examined, an ultrasound scan can reveal a disease such as male hypogonadism (gonadal insufficiency), which is essentially testicular failure, in which the production of sex hormones is reduced.
Detection of calcifications. During ultrasound examination, calcifications are visualized as echo-positive inclusions of high visibility.
In boys, a temporary pathology may be identified such as failure of one testicle to descend into the scrotum. Surgical intervention in this case, it is not necessary until a certain age.
Infertility.
Testicular torsion, that is, compression of the spermatic cord. Occurs during injuries and physical stress. In subacute torsion, Doppler ultrasound is usually performed.
Inflammation of the epididymis (epididymitis). Is the cause of acute pain and swelling of the scrotum in men of any age. Inflammation occurs when an infection enters the prostate gland or Bladder into the epididymis. Doppler ultrasound is more informative than standard B-mode ultrasound. A diffuse or local increase in blood flow is detected in the tissues of the epididymis and the testicle itself.
Tumor on the testicles.
Abscess.
A retention cyst is a neoplasm on the spermatic cord called a spermatocele. Diagnosis is carried out to exclude a malignant nature.
Varicocele is varicose veins century of the spermatic cord. For diagnostics and surgical treatment They use conventional ultrasound in combination with Doppler, as well as with the Valsalva maneuver.
Various injuries.

Why is ultrasound performed on children?

Image of the scrotal organs in men

Ultrasound of the scrotal organs is prescribed to children to determine the full development of the genital organs. Such an examination should be carried out in order to study the functions of the reproductive system and determine the status of the child’s hormones. First of all, an event is carried out to identify pathologies on early stage and fix this problem.

An ultrasound of the scrotum is prescribed for children if the examination revealed an enlargement of the testicles or a change in their shape in the event of an injury to the groin area. If a child has premature puberty or, conversely, is developmentally delayed, then an ultrasound of the scrotum is also indicated for him. Children may experience some abnormalities:

Cysts and tumors.
The occurrence of dropsy due to the inflammatory process.
Failure of one of the testicles to descend into the scrotum.
Poor blood supply to blood vessels.

The child needs psychological preparation before the procedure. He should be told how the examination will be carried out and why it is being done. When performing an ultrasound on a child, it is advisable for parents to be nearby so that the baby does not experience discomfort. There is no need to prepare for the procedure; just take a diaper and napkins to wipe away any remaining gel after the ultrasound examination is completed.

Interpretation of ultrasound indicators

If no pathologies were detected during an ultrasound of the testicles in men, then in the protocol you can read the following indicators that indicate the normality of the organs:

Testicles. Looks good. The dimensions of the testicles of an adult man are 2.5-6 cm in length and 1.5-3 cm in width. The outline should be even. Homogeneous echogenicity. No neoplasms.
Scrotum. The thickness of the walls of a healthy scrotum should be no more than 8 mm.
Appendages. The head parameters are approximately 10-15 mm. No neoplasms. The body and tail should not be visible. Homogeneous echogenic structure. The outlines are smooth, not lumpy.
Free liquid. The amount of free liquid should not exceed 1-2 ml, and the liquid itself should be homogeneous, without impurities.

Interpretation of ultrasound indicators for pathologies

If the disease is present, there may be the following indicators:

Infertility. Cysts may be found that compress the vas deferens.
Epididymitis. Changing the structure of the head and its size. The body and tail of the appendage may be visualized. The presence of fluid, which may indicate the presence of lymphocele, hydrocele and other diseases.
Testicular tumor. Changes in the structure and shape of the testicle. The presence of formations that are located both outside the testicle and on it itself. The echogenic structure of such tumors is reduced. Presence of liquid.
Abscess process on the appendage. The presence of a large neoplasm that has uneven contours and a reduced echogenic structure. Lesions may appear.
Adnexal cyst. It looks like a round smooth formation with liquid inside. The septum inside the cyst may be visible.
The injury is closed. Changes in the structure of the testicle and its uneven contours. The echostructure is heterogeneous. Collection of fluid in the area of injury.

Is there a risk when performing an ultrasound?

Ultrasound machines are based on the principle of ultrasonic waves, therefore this diagnosis does not have a negative impact on human health.

An ultrasound examination is a method for making a timely diagnosis and prescribing effective treatment. Therefore, if any problems arise with men's health, it is recommended to perform an ultrasound.

At an early stage of development, the embryo has prototypes of male and female genital organs - mesonephric (Wolffian) and paramesonephric (Müllerian) canals, respectively. In the seventh week of pregnancy, the Y chromosome triggers the development of the testes. The testes produce testosterone, which promotes the development of mesonephric ducts and suppresses the development of paramesonephric ducts. From 18-20 weeks, you can determine the sex of the fetus by ultrasound.

Structure of the inguinal-scrotal region (according to Prives)

The testicles, testis (Greek - orchis, didymis), are a pair of oval-shaped bodies, somewhat laterally flattened, located in the scrotum. The length of the testicle is on average 4 cm, diameter 3 cm, weight from 15 to 25 g.

The spermatic cord, funiculus spermaticus, and the epididymis, epididymis, approach the posterior edge of the testicle; the latter is located along the rear edge. Epididymis is a narrow long body, in which there is an upper, somewhat thickened part - the head of the appendage, caput epididymidis, and a lower, more pointed end, cauda epididymidis; the intermediate section makes up the body, corpus epididymidis. In the area of the body between the anterior concave surface of the epididymis and the testicle there is a pocket, sinus epididymidis, lined with a serous membrane and open to the lateral side.

At the upper end of the testicle there is often a small appendix testis; on a section it consists of thin tubules; apparently represents a rudimentary process of the paramesonephric duct. On the head of the appendage there is an appendix epididymidis, usually sitting on a stalk (remnant of the Wolffian body, mesonephros).

The testicle is surrounded by a dense, whitish fibrous membrane, tunica albuginea, lying directly on the testicular parenchyma. Along the posterior edge, the membrane protrudes for a short distance into the glandular tissue of the testicle in the form of an incomplete vertical septum or thickening called mediastinum testis; fibrous septa radiate from the mediastinum and are attached to the inner surface tunica albuginea and thus divide the entire parenchyma into lobules. The number of egg lobules reaches 250-300. The apices of the lobules face the mediastinum, and the bases face the tunica albuginea. The epididymis also has tunica albuginea, but is thinner.

The testicular parenchyma consists of seminiferous tubules, in which two sections are distinguished - tubuli semeniferi contori and tubuli seminiferi recti. Each lobule has 2-3 or more tubules. Having a tortuous direction in the lobule itself, the seminiferous tubules, tubuli seminiferi contori, approaching the mediastenum, connect with each other and immediately at the mediastenum narrow into short straight tubes - tubuli seminiferi recti. Straight tubules open into a network of passages - rete testis, located in the thickness of the mediastinum. From the testicular network, 12-15 efferent tubules open - ductuli efferentes testis, which are directed to the head of the epididymis. Upon exiting the testicle, the efferent tubules become tortuous and form a series of conical lobules of the epididymis, lobulus s. coni epididymidis. Ductuli efferentes open into a single canal of the appendage, ductis epididymidis, which, forming numerous bends, continues into the ductis deferens. Once straightened, the appendage canal reaches 3-4 m in length. Ductuli efferentes, lobuli epididydimidis and the initial section of the epididymal canal together form the head of the epididymis. On the epididymis there are side ducts, ductuli aberrantes. Immediately above the head of the appendage, in front of the spermatic cord, there is a small body, paradidymis, which represents a rudimentary remnant of the primary kidney.

The place of secretion of the male seed, sperma, is only the tubuli seminiferi contori. Tubuli recti and testicular tubules already belong to the excretory tract.

The testicles, located in the scrotum, are suspended in it with the help of the spermatic cords. The spermatic cord, funiculus spermaticus, includes the ductus deferens, aa. et vv. testiculares et differentiales, lymphatic vessels and nerves. At the deep ring of the inguinal canal, the components of the spermatic cord diverge, so that the spermatic cord as a whole extends only from the posterior edge of the testicle to the deep ring of the inguinal canal. The spermatic cord is formed only after the testicle descends into the scrotum from the abdominal cavity, where it initially develops.

In lower mammals, the testicle is located in the abdominal cavity. In more highly organized animals, for example, in rodents, it comes out temporarily during the mating period of the animals. These animals have a highly developed muscle that lifts the testicle, m. cremaster, which is reduced in higher mammals and humans, since in them the testicle completely extends from the abdominal cavity into the scrotum. As a reflection of this process, testicular descent is observed in humans during ontogenesis.

In the embryo, the testicles are located on the posterior abdominal wall at the level of the upper two lumbar vertebrae. From the lower end of the testicle, a cord stretches down, the conductor of the testicle, gubernaculum testis, consisting of smooth muscle fibers and fibrous tissue and directed with its lower end to the groin area, being embedded in a fold of the peritoneum. Parallel to the growth of the embryo, the testicle gradually occupies a lower level. At the 3rd month it lies in the iliac fossa, at the 7th month it is located near the deep ring of the inguinal canal.

Much earlier than the exit of the testicle from the abdominal cavity, the peritoneum gives rise to a blind process, processus vaginalis peritonei, which passes through the anterior abdominal wall into the scrotum, receiving membranes from all layers of the abdominal wall on its way. Following the path of the processus vaginalis, the testicle descends into the scrotum, for the most part occupying its final position in it even before the birth of the child. Due to overgrowth of the upper portion of the processus vaginalis, the previously existing connection between the peritoneum and the serous membrane of the testicle is interrupted. If the processus vaginalis does not heal, it remains open channel, through which congenital hernias can emerge.

Along with the release of the testicle from the abdominal cavity, the gubernaculum testis undergoes atrophy. Some authors believe that shortening the conductor during its atrophy partially contributes to the process of testicular descent. If this process is disrupted, the testicle either remains in the abdominal cavity or stops in the inguinal canal, as is observed in animals. This abnormal position of the testicle is a developmental anomaly - and cryptorchidism.

The testicle that has taken its position is located together with lower section spermatic cord in the scrotum, scrotum. By midline the scrotum passes through the suture of the scrotum, raphe scroti, starting on bottom surface penis and extending to the anus area. The remaining surface of the scrotum is covered with a more or less significant number of wrinkles.

The membranes of the testicle and spermatic cord, counting from the outside, are as follows: skin, tunica dartos, fascia spermatica externa, fascia cremasterica, m. cremasterica, fascia spermatica interna, tunica vaginalis testis. This big number The testicular membranes correspond to certain layers of the anterior abdominal wall. It seems as if the testicle, when displaced from the abdominal cavity, carried with it the peritoneum and fascia of the abdominal muscles and became enveloped in them.

The skin of the scrotum is thin and darker in color compared to other parts of the body. It is equipped with numerous large sebaceous glands, the secretion of which has a special characteristic odor.
Tunica dartos, the fleshy membrane, is located immediately under the skin. It is a continuation of the subcutaneous connective tissue from the groin and perineum, but is devoid of fat. It contains a significant amount of smooth muscle fibers. Tunica dartos forms for each testicle one separate sac, connected to each other along the midline, so that a septum, septum scroti, is obtained, attached along the line raphe.
Fascia spermatica externa is a continuation of the superficial fascia of the abdomen.
Fascia cremasterica is a continuation of the fascia intercruralis, extending from the edges of the superficial inguinal ring; she covers m. cremaster, and therefore called f. cremasterica.
M. cremaster consists of bundles of striated fibers, which are a continuation of m. transversus abdominalis. With the contraction of m. cremaster testicle is pulled upward.
Fascia spermatica interna - internal spermatic fascia, located immediately under m. cremaster. it is a continuation of the fascia transverzalis, surrounds all the components of the spermatic cord and is adjacent to the testicle outer surface its serous cover.
Tunica vaginalis testis, the tunica vaginalis of the testis, occurs due to the processus vaginalis of the peritoneum and forms a closed serous sac consisting of two plates: laminaparietalis, the parietal plate, and lamina visceralis, the visceral plate. The visceral plate closely fuses with the tunica albuginea of the testicle and also passes onto the epididymis. Between the lateral surface of the testicle and the middle part of the epididymis (body), the visceral plate enters the fissure space between them, forming a pocket called sinus epididymidis. Along the posterior edge of the testicle, at the site of the exit of the vessels, the visceral plate passes into the parietal plate. Between the parietal and visceral plates facing each other there is a slit-like space - cavum vaginale, in which pathological cases may accumulate a large number of serous fluid and give dropsy of the testicles.

At what age is it necessary to do an ultrasound of the scrotum?

Routine ultrasound examination is carried out at the age of:

6-12 months— By 1 year, the processes of obliteration of the vaginal process of the peritoneum and migration of the testicles should be completely completed. The study at this age is carried out to identify hidden anomalies.
5-9 years— From 5 to 9 years, the size of the testicles increases. Small testicular size may be a sign of hypogonadism or functional developmental delay. Ultrasonic sign The constitutional form of hypogonadism is an increase in testicular volume by more than 2% and sharp increase intraorgan blood flow after injections of choriotropic hormone.
10-14 years— From 10 to 14 years of age, a lumen containing mature spermatogenic cells appears in the convoluted seminiferous tubules. The mass of the testicle doubles. The intensity of regional blood circulation increases proportionally, which is a provoking moment for the occurrence of varicocele. Hidden forms of the disease can be detected on ultrasound using dynamic tests (for more details, see).

Ultrasound of the scrotum

The echostructure of the contents of the scrotum is best seen when scanning with a high-frequency sensor of 7.5-15 MHz. A low-frequency 3.5-5 MHz probe may be useful for scanning the swollen scrotum and great vessels testicles. Ultrasound of the scrotum is performed with the patient in the supine position, a towel between the thighs serves as a support for the scrotum, and the penis is pressed to the abdomen.

Testicle on ultrasound It is an oval formation with smooth contours and a uniform fine-grained structure. Since there is a liquid component in the lumen of the seminiferous tubules, they have a reduced echogenicity, and the stroma and vessels are brighter areas. The number of echogenic structures increases with age and is especially high in the puberty period due to the activation of the processes of vascularization of testicular tissue.

Photo. Transverse section of the testicles: The mediastinum of the testicle is located eccentrically in the cross section (red arrows). The scrotum is divided into two compartments by a fibrous septum. The skin and dartos are hyper- and hypoechoic linear structures. The tunica vaginalis forms a closed serous cavity with a small amount fluid - a thin anechoic zone between hyperechoic linear structures. A cross section of both testicles is useful for comparative analysis echostructure and blood flow.

Photo. Longitudinal section of the testis: In the longitudinal section, the mediastinum of the testis is a hyperechoic line in the center (arrows). The inner layer of the tunica vaginalis is tightly adherent to the tunicae albugineae (arrows) and covers the entire appendage.

To determine the size of the testicle, length and thickness are measured during longitudinal scanning. When scanning transversely, width and thickness are measured. The thickness on the transverse and longitudinal sections is approximately same value.

Testicular volume is calculated using the formula: length (cm) x width (cm) x thickness (cm) x 0.523.

Photo. A - length (1), width (2) and thickness (3). B - width (1), length (2) and thickness (3).

Normal testicular sizes in adults and children of different ages Look .

Epididymis on ultrasound

At an early age, the epididymis on ultrasound its echogenicity does not differ from the echogenicity of the testicles, which is due to the morphological immaturity of both organs. Their structure is dominated by echo-negative shades. The deep sinus with fluid contents between the body of the epididymis and the upper pole of the testicle may not be expressed. The testicle and its epididymis may be mistaken for a single entity and cause measurement errors.

The period of intensive development of the reproductive system begins at the age of 10-14 years. By this time, mature germ cells and seminal fluid appear in the lumen of the seminiferous tubules, which make up the epididymis. Formed appendage on ultrasound: homogeneous heterogeneous semi-oval formation of medium echogenicity with clear contours. The appendage is covered with a tunica albuginea, the head is located in the serous cavity, which takes on the meaning of an “acoustic window”. The tail and a significant part of the body are located outside this cavity and therefore cannot be detected by ultrasound methods.

Photo. The head of the epididymis (blue arrow) is iso- or slightly hyperechoic in relation to the testicle. triangular shape on the upper pole of the testicle. Towards the tail, the tubules become more organized, so the body (red arrows) and tail (yellow arrow) are often hypoechoic.

In the first years of postnatal development of a child, the size of the epididymis approaches the size of the testicle. Until the age of 7, it practically does not change; at the age of 7-11 it doubles. During puberty, the size of the appendage increases several times, reaching 10-15 mm in width and 6-8 mm in thickness. For normal sizes of the epididymis in adults and children of different ages, see.

Hydatids of the testicle and epididymis, which are normal anatomical formations, can be seen with hydrocele (for more details, see. These are formations with a diameter of 2-3 mm, medium echogenicity, attached to the testicle or epididymis.

Inguinal canal on ultrasound

The inguinal canal is studied in B-mode for cryptorchidism and to identify abnormalities of the vaginal process of the peritoneum.

Against the background of fatty tissue, the anterior wall of the inguinal canal, formed by the aponeurosis of the external oblique abdominal muscle, stands out as a separate bright structure and emphasizes the anterior contour of the spermatic cord. The transversalis fascia, constituting the posterior wall, is associated with the peritoneum, highlighting the opposite contour of the cord. The inguinal canal is easier to visualize in men, as the heterogeneous tubular structures of the spermatic cord surrounded by hyperechoic fat are clearly visible.

When searching internal ring of the inguinal canal the reference point is the inferior epigastric artery, which passes accompanied by a vein near the medial edge of the peritoneal infundibulum of the vaginal process. The sensor is placed transversely just below the navel and lowered along the inferior epigastric artery until a convex hyperechoic linear structure appears behind the rectus abdominis muscle - this is top part inguinal canal.

Photo. A, The inferior epigastric arteries and veins (asterisks) arise from the external iliac arteries just above the inguinal ligament (IL), pass posterior to the inguinal canal (IC), and medial to the edge of the deep inguinal ring (D) enter the posterior portions of the rectus abdominis muscle (R). B — With CDK, the epigastric artery and veins (arrow) are clearly visible on the transverse section of the rectus abdominis muscle on the right, just below the navel.

Photo. A, B - When the epigastric vessels leave the rectus abdominis muscle and are directed posterolaterally to the external iliac vessels, an arcuate hyperechoic linear structure (triangles) appears behind the rectus abdominis muscle - this is the upper part of the inguinal canal. On ultrasound, the deep ring of the inguinal canal is visible better in men (A) than in women (B). B - Lateral to the inferior epigastric vessels, when scanning parallel to the inguinal ligament, a hypoechoic abdominal infundibulum of the vaginal process (arrows) is visible - this is the internal ring of the inguinal canal.

Outer ring of the inguinal canal recognized by changes in direction acoustic structures Thomson's and superficial fascia, which in this place move to the spermatic cord. This transition is clearly visible when scanning the cord at the root of the scrotum.

The length of the inguinal canal in children of the first year of life varies between 0.5-2.5 cm. With age, it lengthens and becomes narrower.

The spermatic cord on ultrasound

The spermatic cord is the structure that passes through the inguinal rings as the testicles descend into the scrotum. The spermatic cord includes the remnants of the tunica vaginalis, the vas deferens, lymphatic vessels, the testicular artery, the cremasteric artery and the vas deferens artery, as well as veins. The veins form a network of anastomoses - the pampiniform (pampiniform) plexus, which runs along back surface testicles and along a significant length of the vas deferens. At the level of the deep inguinal ring they transform into a testicular vein.

Ultrasound of the spermatic cord represented by linear structures that correspond to the arterial and venous vessels passing here. The vas deferens is not detected by echography.

Photo. Transverse scan of the groin area just below the inguinal ligament. Inward from the general femoral artery(A) and vein (V) the vas deferens and the vessels of the spermatic cord in the inguinal canal are visible - these are oval-shaped anechoic structures (arrows). For comparison, a similar scan is performed on the contralateral side (A and B, C and D). In image C, the structures of the spermatic cord are not identified. If it is not possible to detect the testicle in the inguinal canal, then the testicles are searched in the abdominal cavity along the iliac vessels up to the bifurcation of the aorta and in the pelvis. If necessary, use a lower frequency sensor.

Intraorgan arteries and veins of the testicles are well defined by colorectal dosage, especially in the ED mode. The color cartogram is characterized by a uniform distribution of blood flows throughout the parenchyma. The superficial network of vessels localized in the inner layer of the tunica albuginea (tunica vasculosa) stands out more clearly. In children, the intensity of blood circulation increases in proportion to age. In prepubertal and puberty it becomes possible to quantitatively and qualitative analysis blood flow

Intratesticular arteries have low peripheral resistance. Blood flow in the main trunk of the testicular artery, which is best identified in the space between the head of the epididymis and the upper pole of the testicle, can be characterized in a similar way. The blood flow in the arteries of the spermatic cord may have a main altered type of Doppler spectrum, so the interlobular arteries are more sensitive to various influences.

Important area Ultrasound examination is the initial section of the spermatic cord from the place of its formation to the level of the superficial inguinal ring. The veins of the pampiniform plexus are especially well visualized here, the diameter of which normally varies from 0.5 to 3 mm. The pampiniform plexus includes from 10 to 45 vessels, complexly and repeatedly anastomosing with each other. In B-mode, the vascular geometry of the venous plexus is clarified, and the presence or absence of varicose veins is determined.

Using the CDC, the condition of the valve apparatus in venous system according to stress tests. When the patient's body position changes from horizontal to vertical, the direction of blood flow in the color cartogram normally remains in the correct direction, anterograde. When you take a deep breath with held breath while the valves are functioning, the veins become empty. As you exhale, the natural direction of blood flow is resumed and increases in intensity. With coughing movements, the blood flow becomes intermittent, but anterograde. The diameter of the veins should not increase by more than 1 mm when the muscles of the anterior abdominal wall are tense. A negative result of functional stress tests indicates valvular venous insufficiency (for more details, see).

Vascular examinations of the inguinal canal are performed primarily to identify inguinal canal. The testicular artery, cremasteric artery, and vas deferens artery have approximately similar Doppler characteristics and are difficult to verify.

Pay attention to the RI of the interlobular arteries of the testicle. Normally RI is 0.6-0.7. With arteriovenous shunting and collateral circulation, RI decreases. When RI is below 0.4, the sperm is of poor quality.

Drawing. Ultrasound shows a normal testicle. The spectrum of interlobular arteries has a smooth rise, a rounded systolic peak, a gentle descent and a pronounced end-diastolic component.

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Topic: ultrasound examination of organs and tissues (instructions for use).

Features of ultrasound of the scrotum

For ultrasound examination of the scrotum, linear sensors of 5-12 MHz are used.

During ultrasound of the scrotum, a longitudinal image of the testicle and its poles, head of the epididymis, body and tail is obtained, and then a transverse image is obtained to assess the echostructure, contours, size, and presence of formations. The symmetry of the findings is compared with the contralateral testis and epididymis. The examination is complemented by an assessment of vascularization and hemodynamics in ultrasound angiography modes (color Doppler mapping and color Doppler mapping by energy). To exclude varicocele, a stress test (Valsalva maneuver) is performed.

Protocol for ultrasound examination of the scrotal organs

We present a unified protocol for ultrasound of the scrotal organs, which indicates the required minimum diagnostic steps when conducting the study. In this case, each specific institution can use additional ultrasound characteristics and criteria.

ULTRASOUND EXAMINATION OF THE Scrotum ORGANS (protocol)

Full name _________ Age ___

Date of examination _________

Testicles: right | left dimensions ___mm | ___mm

volume ___ cm3 | ___ cm3

Features of echostructure ___ | ___ Vascularization ___ | ___ Outlines ___ | ___

Capsule ___ | ___

Load test: ______

Conclusion __________________ Doctor _________

The average salary of a doctor in the USA is $294,000 per year (from 202 thousand for pediatricians and up to 489 thousand for orthopedists)

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Ultrasound of the scrotum (lecture at Diagnostic) - Diagnostic

Structure of the inguinal-scrotal region (according to Prives)

The testicle is surrounded by a dense, whitish fibrous membrane, tunica albuginea, lying directly on the testicular parenchyma. Along the posterior edge, the membrane protrudes for a short distance into the glandular tissue of the testicle in the form of an incomplete vertical septum or thickening called mediastinum testis; Fibrous septa radiate from the mediastinum, which with their outer ends are attached to the inner surface of the tunica albuginea and thus divide the entire parenchyma into lobules. The number of egg lobules reaches 250-300. The apices of the lobules face the mediastinum, and the bases face the tunica albuginea. The epididymis also has tunica albuginea, but is thinner.

The place of secretion of the male seed, sperma, is only the tubuli seminiferi contori. Tubuli recti and testicular tubules already belong to the excretory tract.

In the embryo, the testicles are located on the posterior abdominal wall at the level of the upper two lumbar vertebrae. From the lower end of the testicle, a cord stretches down, the conductor of the testicle, gubernaculum testis, consisting of smooth muscle fibers and fibrous tissue and directed with its lower end to the groin area, being embedded in the fold of the peritoneum. Parallel to the growth of the embryo, the testicle gradually occupies a lower level. At the 3rd month it lies in the iliac fossa, at the 7th month it is located near the deep ring of the inguinal canal.

Much earlier than the exit of the testicle from the abdominal cavity, the peritoneum gives rise to a blind process, processus vaginalis peritonei, which passes through the anterior abdominal wall into the scrotum, receiving membranes from all layers of the abdominal wall on its way. Following the path of the processus vaginalis, the testicle descends into the scrotum, for the most part occupying its final position in it even before the birth of the child. Due to overgrowth of the upper portion of the processus vaginalis, the previously existing connection between the peritoneum and the serous membrane of the testicle is interrupted. If the processus vaginalis does not heal, an open canal remains through which congenital hernias can emerge.

The testicle, which has taken its position, is located together with the lower part of the spermatic cord in the scrotum, scrotum. Along the midline of the scrotum there is a suture of the scrotum, raphe scroti, starting on the lower surface of the penis and extending to the anus. The remaining surface of the scrotum is covered with a more or less significant number of wrinkles.

The membranes of the testicle and spermatic cord, counting from the outside, are as follows: skin, tunica dartos, fascia spermatica externa, fascia cremasterica, m. cremasterica, fascia spermatica interna, tunica vaginalis testis. Such a large number of testicular membranes corresponds to certain layers of the anterior abdominal wall. It seems as if the testicle, when displaced from the abdominal cavity, carried with it the peritoneum and fascia of the abdominal muscles and became enveloped in them.

The skin of the scrotum is thin and darker in color compared to other parts of the body. It is equipped with numerous large sebaceous glands, the secretion of which has a special characteristic odor.
Tunica dartos, the fleshy membrane, is located immediately under the skin. It is a continuation of the subcutaneous connective tissue from the groin and perineum, but is devoid of fat. It contains a significant amount of smooth muscle fibers. Tunica dartos forms for each testicle one separate sac, connected to each other along the midline, so that a septum, septum scroti, is obtained, attached along the line raphe.
Fascia spermatica externa is a continuation of the superficial fascia of the abdomen.
Fascia cremasterica is a continuation of the fascia intercruralis, extending from the edges of the superficial inguinal ring; she covers m. cremaster, and therefore called f. cremasterica.
M. cremaster consists of bundles of striated fibers, which are a continuation of m. transversus abdominalis. With the contraction of m. cremaster testicle is pulled upward.
Fascia spermatica interna - internal spermatic fascia, located immediately under m. cremaster. it is a continuation of the fascia transverzalis, surrounds all the components of the spermatic cord and in the area of the testicle is adjacent to the outer surface of its serous cover.
Tunica vaginalis testis, the tunica vaginalis of the testis, occurs due to the processus vaginalis of the peritoneum and forms a closed serous sac consisting of two plates: laminaparietalis, the parietal plate, and lamina visceralis, the visceral plate. The visceral plate closely fuses with the tunica albuginea of the testicle and also passes onto the epididymis. Between the lateral surface of the testicle and the middle part of the epididymis (body), the visceral plate enters the fissure space between them, forming a pocket called sinus epididymidis. Along the posterior edge of the testicle, at the site of the exit of the vessels, the visceral plate passes into the parietal plate. Between the parietal and visceral plates facing each other there is a slit-like space - cavum vaginale, in which in pathological cases a large amount of serous fluid can accumulate and give rise to testicular hydrocele.

At what age is it necessary to do an ultrasound of the scrotum?

Routine ultrasound examination is carried out at the age of:

6-12 months - By 1 year, the processes of obliteration of the vaginal process of the peritoneum and migration of the testicles should be completely completed. The study at this age is carried out to identify hidden anomalies.
5-9 years - From 5 to 9 years the size of the testicles increases. Small testicular size may be a sign of hypogonadism or functional developmental delay. An ultrasound sign of the constitutional form of hypogonadism is an increase in testicular volume by more than 2% and a sharp increase in intraorgan blood flow after injections of choriotropic hormone.
10-14 years - From 10 to 14 years, a lumen containing mature spermatogenic cells appears in the convoluted seminiferous tubules. The mass of the testicle doubles. The intensity of regional blood circulation increases proportionally, which is a provoking moment for the occurrence of varicocele. Hidden forms of the disease can be detected on ultrasound using dynamic tests (read more here).

Ultrasound of the scrotum

The echostructure of the contents of the scrotum is best seen when scanning with a high-frequency sensor of 7.5-15 MHz. A low-frequency 3.5-5 MHz sensor may be useful for scanning the swollen scrotum and great vessels of the testicle. Ultrasound of the scrotum is performed with the patient in the supine position, a towel between the thighs serves as a support for the scrotum, and the penis is pressed to the abdomen.

The testicle on ultrasound is an oval formation with smooth contours and a uniform fine-grained structure. Since there is a liquid component in the lumen of the seminiferous tubules, they have a reduced echogenicity, and the stroma and vessels are brighter areas. The number of echogenic structures increases with age and is especially high in the puberty period due to the activation of the processes of vascularization of testicular tissue.

Testicular volume is calculated using the formula: length (cm) x width (cm) x thickness (cm) x 0.523.

See the normal sizes of testicles in adults and children of different ages here.

Epididymis on ultrasound

At an early age, the epididymis on ultrasound does not differ in echogenicity from the echogenicity of the testicles, which is due to the morphological immaturity of both organs. Their structure is dominated by echo-negative shades. The deep sinus with fluid contents between the body of the epididymis and the upper pole of the testicle may not be expressed. The testicle and its epididymis may be mistaken for a single entity and cause measurement errors.

The period of intensive development of the reproductive system begins at the age of 10-14 years. By this time, mature germ cells and seminal fluid appear in the lumen of the seminiferous tubules, which make up the epididymis. Formed appendage on ultrasound: a homogeneous heterogeneous semi-oval formation of medium echogenicity with clear contours. The appendage is covered with a tunica albuginea, the head is located in the serous cavity, which takes on the meaning of an “acoustic window”. The tail and a significant part of the body are located outside this cavity and therefore cannot be detected by ultrasound methods.

In the first years of postnatal development of a child, the size of the epididymis approaches the size of the testicle. Until the age of 7, it practically does not change; at the age of 7-11 it doubles. During puberty, the size of the appendage increases several times, reaching 10-15 mm in width and 6-8 mm in thickness. See the normal sizes of the epididymis in adults and children of different ages here.

Hydatids of the testicle and epididymis, which are normal anatomical structures, can be seen with hydrocele (see more details here). These are formations with a diameter of 2-3 mm, medium echogenicity, attached to the testicle or epididymis.

Inguinal canal on ultrasound

The inguinal canal is studied in B-mode for cryptorchidism and to identify abnormalities of the vaginal process of the peritoneum.

When searching for the internal ring of the inguinal canal, the reference point is the inferior epigastric artery, which passes accompanied by a vein near the medial edge of the peritoneal infundibulum of the processus vaginalis. The sensor is placed transversely just below the navel and lowered along the inferior epigastric artery until a convex hyperechoic linear structure appears behind the rectus abdominis muscle - this is the upper part of the inguinal canal.

The outer ring of the inguinal canal is recognized by a change in the direction of the acoustic structures of the Thomsonian and superficial fascia, which in this place move to the spermatic cord. This transition is clearly visible when scanning the cord at the root of the scrotum.

The length of the inguinal canal in children of the first year of life varies between 0.5-2.5 cm. With age, it lengthens and becomes narrower.

The spermatic cord on ultrasound

The spermatic cord is the structure that passes through the inguinal rings as the testicles descend into the scrotum. The spermatic cord includes the remnants of the tunica vaginalis, the vas deferens, lymphatic vessels, the testicular artery, the cremasteric artery and the vas deferens artery, as well as veins. The veins form a network of anastomoses - a pampiniform (pampiniform) plexus, which runs along the posterior surface of the testicles and along a significant length of the vas deferens. At the level of the deep inguinal ring they transform into a testicular vein.

On ultrasound, the spermatic cord is represented by linear structures that correspond to the arterial and venous vessels passing here. The vas deferens is not detected by echography.

Testicular Doppler

Intraorgan arteries and veins of the testicles are well defined by colorectal dosage, especially in the ED mode. The color cartogram is characterized by a uniform distribution of blood flows throughout the parenchyma. The superficial network of vessels localized in the inner layer of the tunica albuginea (tunica vasculosa) stands out more clearly. In children, the intensity of blood circulation increases in proportion to age. In prepubertal and pubertal adolescents, quantitative and qualitative analysis of blood flow becomes possible.

An important area of ultrasound examination is the initial part of the spermatic cord from the place of its formation to the level of the superficial inguinal ring. The veins of the pampiniform plexus are especially well visualized here, the diameter of which normally varies from 0.5 to 3 mm. The pampiniform plexus includes from 10 to 45 vessels, complexly and repeatedly anastomosing with each other. In B-mode, the vascular geometry of the venous plexus is clarified, and the presence or absence of varicose veins is determined.

With the help of CDK, the state of the valve apparatus in the venous system is determined using stress tests. When the patient's body position changes from horizontal to vertical, the direction of blood flow in the color cartogram normally remains in the correct direction, anterograde. When you take a deep breath with held breath while the valves are functioning, the veins become empty. As you exhale, the natural direction of blood flow is resumed and increases in intensity. With coughing movements, the blood flow becomes intermittent, but anterograde. The diameter of the veins should not increase by more than 1 mm when the muscles of the anterior abdominal wall are tense. A negative result of functional stress tests indicates valvular venous insufficiency (for more details, see here).

Vascular examinations of the inguinal canal are performed primarily to identify the inguinal canal. The testicular artery, cremasteric artery, and vas deferens artery have approximately similar Doppler characteristics and are difficult to verify.

Drawing. Ultrasound shows a normal testicle. The spectrum of interlobular arteries has a smooth rise, a rounded systolic peak, a gentle descent and a pronounced end-diastolic component.

Take care of yourself, Your Diagnosticer!

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Ultrasound of the organs and vessels of the scrotum: norms, explanation, how to do a Doppler study

For urological problems, ultrasound of the scrotal organs is often prescribed. The scrotum is a musculocutaneous sac-like formation in men, which includes organs such as the testicles, spermatic cords and epididymis. The organs are located in such a way that they can only be examined using an ultrasound examination.

The ultrasound examination procedure allows for a high-quality and informative diagnosis and assessment of the condition of the male reproductive organs.

Advantages of this procedure

Using ultrasound, the man’s genitals are scanned and the internal condition is assessed. Ultrasound has its advantages:

An absolutely safe method that does not irradiate the body. The result is very informative and accurate;
using Doppler ultrasound, you can assess not only the condition of the organs located in the scrotum, but also view the circulatory system;
a contact method of examination that does not cause discomfort or pain.

Indications for use

Usually, an ultrasound is prescribed by a urologist. Additionally, an ultrasound examination with Doppler may be performed to determine the condition of the vessels of a given organ. Indications for examination:

carried out to monitor the organ after operations;
with a diagnosis of “male infertility”;
the risk of the hernia spreading to the groin area;
with enlargement of the testicles and their appendages;
the presence of diseases of the endocrine system;
lack of erection;
if the patient does not have one or both testicles;
the appearance of pain in the scrotum and its swelling;
in the presence of tumors or chronic diseases;
suspicion of inflammatory processes;
suspicion of the appearance of varicose veins of the testicle or spermatic cord (varicocele);
after suffering an injury;
sometimes an examination is carried out for enlarged lymph nodes;
if tumors appear on the scrotum;
examination is carried out in adolescence to determine early or late puberty;
poor sperm count.

Carrying out the procedure

Photo ultrasound image of the scrotum - testicles

Before performing the examination procedure on the scrotal organs, no special preparation is needed.

The study is performed in a lying position. A conductive contact gel is applied to the desired area for examination. It is advisable that the gel is not cold, otherwise the cold may cause the testicles to be drawn into the abdominal cavity, which will not allow the examination to be carried out as needed.

If pain occurs in the area of the scrotal organs upon contact with the sensors (in the case of tumors of unknown etiology), then local anesthesia is performed.

First, the condition and structure of one testicle is examined, then the second.

When performing an ultrasound with Doppler, the venous plexuses and the condition of the vessels in the groin area are carefully checked.

The ultrasound examination procedure itself is performed within 15 minutes, in some cases, for example, when visualization of organs is difficult, it can last up to half an hour.

Ultrasound with Doppler ultrasound

This procedure is aimed at studying the vessels, veins, capillaries and blood flow, its direction in the groin area and its organs. Using Doppler you can evaluate:

level of enrichment of the scrotal organs with blood;
assessment of the rate of blood supply, the volume of blood supplied;
condition of blood vessels, their structure and walls.

Dopplerography of the vessels of the groin area does not require special preparation.

Doppler examination allows the doctor to identify the weakest points of the vascular bed in the groin area and prescribe appropriate treatment.

What diseases can be detected by ultrasound

Testicular cysts. They are single, unilateral small neoplasms, usually detected by a sonologist in the middle of the gonad. Testicular cysts can be congenital or acquired (neoplasms of the epididymis), the latter often simulating hydrocele.
Congenital dropsy (hydrocele) of one or both testicles.
An ultrasound scan of the scrotum may reveal tumors.
If a child is examined, an ultrasound scan can reveal a disease such as male hypogonadism (gonadal insufficiency), which is essentially testicular failure, in which the production of sex hormones is reduced.
Detection of calcifications. During ultrasound examination, calcifications are visualized as echo-positive inclusions of high visibility.
In boys, a temporary pathology may be identified such as failure of one testicle to descend into the scrotum. In this case, surgical intervention is not necessary until a certain age.
Infertility.
Testicular torsion, that is, compression of the spermatic cord. Occurs during injuries and physical stress. In subacute torsion, Doppler ultrasound is usually performed.
Inflammation of the epididymis (epididymitis). It causes acute pain and swelling of the scrotum in men of any age. Inflammation occurs when an infection from the prostate or bladder enters the epididymis. Doppler ultrasound is more informative than standard B-mode ultrasound. A diffuse or local increase in blood flow is detected in the tissues of the epididymis and the testicle itself.
Tumor on the testicles.
Abscess.
A retention cyst is a neoplasm on the spermatic cord called a spermatocele. Diagnosis is carried out to exclude a malignant nature.
Varicocele is a varicose vein in the spermatic cord. For diagnosis and surgical treatment, conventional ultrasound is used in combination with Doppler, as well as with the Valsalva maneuver.
Various injuries.

Why is ultrasound performed on children?

Image of the scrotal organs in men

Cysts and tumors.
The occurrence of dropsy due to the inflammatory process.
Failure of one of the testicles to descend into the scrotum.
Poor blood supply to blood vessels.

Interpretation of ultrasound indicators

If no pathologies were detected during an ultrasound of the testicles in men, then in the protocol you can read the following indicators that indicate the normality of the organs:

Testicles. Looks good. The dimensions of the testicles of an adult man are 2.5-6 cm in length and 1.5-3 cm in width. The outline should be even. Homogeneous echogenicity. No neoplasms.
Scrotum. The thickness of the walls of a healthy scrotum should be no more than 8 mm.
Appendages. The head parameters are approximately 10-15 mm. No neoplasms. The body and tail should not be visible. Homogeneous echogenic structure. The outlines are smooth, not lumpy.
Free liquid. The amount of free liquid should not exceed 1-2 ml, and the liquid itself should be homogeneous, without impurities.

Interpretation of ultrasound indicators for pathologies

If the disease is present, there may be the following indicators:

Infertility. Cysts may be found that compress the vas deferens.
Epididymitis. Changing the structure of the head and its size. The body and tail of the appendage may be visualized. The presence of fluid, which may indicate the presence of lymphocele, hydrocele and other diseases.
Testicular tumor. Changes in the structure and shape of the testicle. The presence of formations that are located both outside the testicle and on it itself. The echogenic structure of such tumors is reduced. Presence of liquid.
Abscess process on the appendage. The presence of a large neoplasm that has uneven contours and a reduced echogenic structure. Lesions may appear.
Adnexal cyst. It looks like a round smooth formation with liquid inside. The septum inside the cyst may be visible.
The injury is closed. Changes in the structure of the testicle and its uneven contours. The echostructure is heterogeneous. Collection of fluid in the area of injury.

Is there a risk when performing an ultrasound?

Ultrasound machines are based on the principle of ultrasonic waves, so this diagnosis does not have a negative impact on human health.

An ultrasound examination is a method for making a timely diagnosis and prescribing effective treatment. Therefore, if any problems with men's health arise, it is recommended to conduct an ultrasound.