Scrotum Pt Position & Protocol

• Clinical Questions

  • Was this patient referred because of palpable mass, scrotal pain, swollen scrotum, or other reason?
  • Ask patient to describe symptoms, including history, location, and duration of pain.
  • Can he feel a mass? If so, ask patient to find lump. Place probe exactly over this location to examine site.
  • Did patient experience trauma? When did trauma occur? Describe what happened.
  • Vasectomy procedure? When?
• Patient Positioning

  • Supine position
  • Penis positioned on abdomen and covered with towel
  • Patient asked to place legs close together to provide support for scrotum
  • Rolled towel placed between thighs can support scrotum
• Protocol

  1. Apply generous amount of warmed gel to scrotum

  2. High-frequency probes (10 to 14 MHz)

  3. Bilateral exam, with asymptomatic side used as comparison for symptomatic side

  4. Each testis scanned from superior to inferior

  5. Size, echogenicity, and structure of each testis evaluated

  6. Testicular parenchyma should be uniform with an equal echogenicity between sides
• Evaluation

  • Is the parenchyma homogeneous or heterogeneous?
  • Is there a mass? If so, is it cystic or solid?
  • Is the mass intratesticular or extratesticular?
• Evaluation

  • Is one testis much larger than other? Is one side swollen, or is one side shrunken?
  • Each testis should appear similar in size and shape. Is epididymis normal? Is skin thickened?
  • Turn on color Doppler to assess flow. Is there an absence of flow in testis or is it hyperemic? How does color Doppler compare between sides?
  • Check flow in each epididymis.
• Protocol

  1. SAGITTAL IMAGE

  2. Spermatic cord area

  3. Epididymal body and tail

  4. Epididymal head with superior teste

  5. Color Doppler of Epi Head

  6. Meas Epi Head

  7. Long axis mid teste w/ meas

  8. Mid teste with color Doppler

  9. Mid teste with spectral Doppler

  10. Medial long axis

  11. Lateral long axis
• Protocol

  1. TRANSVERSE IMAGE

  2. TRV view showing both testes

  3. With and without color Doppler

  4. Epididymal head

  5. Superior testis

  6. Mid testis with measurement

  7. Inferior testis
• Protocol

  1. Pampiniform Plexus

  2. With and without color Doppler

  3. With and without valsalva

  4. Meas if appears dilated

  5. Scrotum wall

  6. Meas if appears thickened

  7. Evaluate wall interface from scrotum/inguinal
• Technical Considerations

  • Transducer selection
  • Color Doppler and power Doppler
  • Gain
  • PRF
  • Wall filter
  • Line density
  • Threshold
  • Packet size
• Reporting

  • Echogenicity
  • Vascularity
  • Dilation
  • Fluid collection
  • Hernia
  • Pathology