Congenial anomalies, cysts, and calcifications of Testicles

Polyorchidism

Three or more testicles present

Polyorchidism

Testes normally descend into the scrotal sac between ____________ GA

26-34 weeks

Cryptorchidism

Undescended testes

Most undescended testes are palpable in inguinal canal area (70-80%)

Infertility and cancer are common complications

CT or MRI may be needed to locate the testes if they are in the abdomen

The undescended testicle is usually removed because of the risk of cancer

• Orchiopexy → corrects cryptorchidism

Cryptorchidism USA

Identify echogenic mediastinum testis to distinguish cryptorchid testis

Absent testicle in scrotal sac

Usually found in ipsilateral inguinal canal

Hypoechoic, homogeneous

Almond shape

Well circumscribed

Cryptorchidism

Tunica albuginea cyst

Within the tunica surrounding testis

Located at the outer border of the testicle

Usually solitary and unilocular

Tunica albuginea cyst USA

Well defined margins

Through transmission and enhancement

Tunica vaginalis cyst

Rare

Single or multiple

May contain septations or hemorrhage

Difficult to differentiate from tunica albuginea cysts

Intratesticular cysts

Simple cysts

Usually <2cm

Thought to originate from the rete testis

Located within the testicular parenchyma

Intratesticular cysts USA

Well defined, smooth walls

Anechoic

Through transmission and posterior enhancement

Tunica albuginea

Intratesticular cyst

Tubular ectasia of rete testis

Associated with epididymal inflammation or trauma

Usually bilateral and seen with spermatocele

Vessels also course through the rete testis

If color is seen within the tiny cystic areas, an intratesticular varicocele is present and the scrotal veins should be evaluated for dilation and reflux

Tubular ectasia of rete testis USA

Multiple tiny cystic areas in the area of the mediastinum testis that do not fill with color

Dilated rete testis

Cystic dysplasia

Rare congenital malformation

Multiple cysts of different sizes with septations

Begins at mediastinum testis area and extends into parenchyma nearby

Frequently seen with renal agenesis or dysplasia

Epidermoid cyst

Benign teratoma

Walls are fibrous, may calcify

Described as having an onion or target appearance due to altering rings of hyperechoic tissues

Cyst contains thick keratin

USA Epidermoid cyst

Well defined hypoechoic mass

Thickened or calcified wall

May have “onion” appearance internally

Avascular

Epidermoid cyst

Simple epididymal cyst

Caused by dilation of the epididymal tubules

Found throughout the epididymis (head, body, tail)

Contain serous fluid

Simple epididymal cyst USA

Anechoic, well-circumscribed

Can be multiple

Most common scrotal mass

Spermatocele

Spermatocele

Caused by dilation of the epididymal tubules

Usually found ONLY IN THE HEAD OF EPI

Contain spermatozoa and sediment

Commonly seen in post-vasectomy patients

Spermatocele USA

Anechoic, well-circumscribed

Similar to simple cyst but may have low-level echoes

Spermatocele

Scattered calcifications seen with:

Tuberculosis, filariasis, previous trauma

Coarse calcifications seen with:

Sertoli cell tumors

Burned out germ cells

Microlithiasis

Germ cell tumors

Cryptorchidism

Trisomy 21 and Klinefelter’s syndrome

Previous radiotherapy

Microlithiasis

Extrascrotal calcifications

Scrotal pearls

Arise between the two layers of tunica vaginalis

May be loose within the scrotal sac

Extrascrotal calcifications USA

Echogenic foci with posterior shadowing outside the testicle, but within scrotal sac

Mobile

Twinkle artifact on doppler

Extrascrotal calcifications/ Scrotal pearl

Post vasectomy changes

Epididymal enlargement

Tubular ectasia of epi

Spermatoceles and cysts

Dilated vas deferens

How can you differentiate an undescended testicle from an inguinal mass

Locate the mediastinum testis

How can you differentiate a tunica albuginea cyst from an intratesticular cyst

Location of the cyst

An epidermoid cyst us described as having the appearance of:

An onion

How can you differentiate an epidermoid cyst from a scortal tumor?

Activate color

A spermatocele is a common finding in patients with a Hx of:

Vasectomy

A scrotolith is identified:

Outside the testicle, within scrotal sac