Ultrasonography of the Scrotum: Technique, Anatomy, and Pathologic Entities

Objective: To review the ultrasonographic technique, anatomy, and pathologic entities found in the scrotum during evaluation of scrotal masses, acute scrotal pain, and male infertility.

Method: A pictorial review of cases with diagrams of pertinent anatomic features and findings is presented.

Results: Ultrasonography in conjunction with color and pulsed Doppler imaging has supplanted other imaging modalities in the evaluation of scrotal diseases and disorders. Ultrasonography is valuable in the evaluation of the acutely painful scrotum in addition to scrotal masses and male infertility. Advances in ultrasonographic spatial and low-contrast resolution have improved our ability to more clearly define diagnoses for the referring urologist and have led to new observations that are currently being investigated and have yet to be fully understood. Microlithiasis and the mottled appearance of seminiferous tubule sclerosis and atrophy are 2 such entities. This article reviews the pertinent normal scrotal anatomy and the use of ultrasonography in the evaluation and classification of acute scrotal pain, scrotal masses, male infertility, and trauma. This review article also discusses pitfalls of color Doppler imaging in assessment of the scrotum and how to avoid them.

Conclusion: The use of ultrasonography in the evaluation of the scrotum benefits from an understanding of scrotal anatomy and familiarity with potential pitfalls of color Doppler and pulsed Doppler evaluation.