TESTICULAR IMAGING GOG LASUCOM/18/09/12 SCROTUM -A Pouch of skin that houses the TESTES. Epididymis and spermatic cord.

-Has three layers-from superficial to deep skin-Dartos muscle and colles fascia. -Divided into two compartments by midline fibrous septum ( median Raphe ). -Each compartment contains a testicle, epididymis and spermatic cord. The testicles originate from the posterior abdominal wall around the level of L1 and descend retroperitoneally through the abdomen with associated neurovascular structures lymphatics , ducts exit the pelvis via the inguinal canal into the scrotum.

 Anatomy Adult testes are ovoid glands measuring 3-5cm in length, 2-4cm in width and 3cm in anteroposterior dimension. Each testis weight from 12.5-19grams. Testicular size and weight decrease with age. Testes are surrounded by a dense white fibrous capsule - Tunica Albuginea. Epididymis is a curved structure 6-7cm in length lying posterolateral to the testis. Diagnostic Ultrasound is the most common imaging technique used in supplementing physical examination of the scrotum. IMAGING OF THE TESTIS KUB ULTRASOUND RUCG MRI CT SCAN DOPPLER SCAN RADIONUCLIDE IMAGING - SCROTAL SCINTIGRAPHY ANGIOGRAPHY VASOGRAPHY

 UNDESCENDED TESTIS (CRYPTORCHIDISM) In majority of prepubertal males, the testes may normally be retractile into the groin because of the cremasteric muscle reflex. Once the testicle cannot be located within the scrotum it can be considered undescended. Failure of descent by 2-3years age is associated with abnormal development Testes that remain undescended in boys above 5 years suffer from an increased incidence of malignant neoplasia up to 40 times. ULTRA SOUND-(quick and able to locate the testicle at its commonest sites {within the inguinal canal or just proximal to it} ) 1st Line Investigation to locate an undescended testicle. The longer the testis has been undescended the more likely it is to be small, atrophic and echo-poor. MRI- for more expansive search; better than CT as it avoids radiation. Testicle shows a conspicuous high signal on T2-weighted and STIR sequences. Testicular Phlebography or Arteriography in search for undescended testis.

 EXTRATESTICULAR SCROTAL DISORDERS Hydrocele(epididymo- orchitis, trauma, infarction {torsion}) or- formation of fluid between the 2layers(visceral and parietal of the tunica vaginalis . -seen ultasonographically, it is seen as an echo-free area partly surrounding the testicle. Cyst varicocele TESTICULAR DISORDERS ORCHITIS Testicular appendix torsion Scrotal trauma Testicular masses Testicular lymphoma Testicular microlithiasis Testicular calcification

 Current Uses of Scrotal Sonography Evaluation of location and characteristics of scrotal masses. Detection of occult primary tumor in patients in the known metastatic disease. Follow up of the patients with Microlithiasis. Follow up of patients with leukemia, lymphoma and previous testicular neoplasm. Evaluation of extra testicular pathologic lesions. Evaluation of Acute Scrotal pain. Evaluation of Scrotal trauma. Localisation of an undescended testis.

 Detection of varicoceles in infertile men. Evaluation of testicular/ischemia with color flow Doppler. Technique The Scrotum is elevated with a towel draped over the thighs while the penis is placed on the patients abdomen covered with a towel. Scrotal sac may be supported by the examiners hand. Images of both testes are obtained in transverse and sagittal planes. Color flow Doppler examinations are done to evaluate testicular blood flow in normal and pathologic states.