Background: The scrotum is a readily examinable structure clinically in normal conditions. However, in cases of swelling and tenderness, its clinical examination alone may not reveal any significant information. Therefore, imaging techniques such as ultrasound including CT and MRI may be required in cases. We in the current study tried to evaluate the role of ultrasound, CT, and MRI in the evaluation of scrotal pathologies.
The scrotum is a musculo-fascial sac containing the testes,epididymis, and the lower part of the spermatic cord. The scrotum is divided into right and left parts by a ridge or median raphe. The raphe is continued to the undersurface of the penis and posteriorly along the midline to the perineum to the anus. The clinical examination of these structures is very easy especially in absence of pathology. Most of the disease of scrotum causes swellings and tenderness which are difficult to diagnose based on physical examination alone. There is a greater difficulty to decide the swelling is from intra-testicular or extra testicular structures. Acute pathological conditions such as testicular torsion and acute epididymal-orchitis hamper the diagnosis due to overlapping clinical features.
This cross-sectional study was performed in the Department of Radiology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Institutional Ethical committee permission was obtained for the study. Written consent was obtained from all the participants of the study in a designated format. All the cases of scrotal pathologies referred from the Departments of Urology and General Surgery were included in the study. All the patients were studied using High-frequency real-time grayscale ultrasonography and Doppler. Before subjecting the patients for ultrasound examination, patient details, detailed clinical history was obtained along with thorough physical examination. The color Doppler sonography was routinely performed in all these patients. Subsequently, these cases were followed up and correlated with histopathology report,fine needle aspiration cytology results, surgical findings, response to treatment. Follow-up scans were done in selected cases when clinically indicated. An abdominal ultrasound scan was done in conjunction with scrotal scans in cases of testicular malignancy to look for associated pathology, in cases of varicoceles to look for any cause of testicular vein obstruction. Conventional radiography was done wherever indicated. In this studyusing High-resolution real-time grayscale ultrasonographyand Doppler study of the scrotum was carried out using 7.5 to 10
MHz linear transducers, abdominal ultrasonography was done using 3.5 to 5.0 MHz convex curved array transducer of PHILIPS HD7 ULTRASOUND SYSTEM andCT:TOSHIBA Auklet single-slice spiral CT, MRI: GE Sigma EXCITE 0.2T open magnet.Scanning technique:Scanning was routinely performed in the supine position, after elevating the scrotum using a towel draped over thighs, and the penis is placed on the patient's abdomen and covered with a towel. Both hemiscrotum was examined in transverse, sagittal, and oblique planes. Scanning was also done with the patient position upright and during performing Valsalva maneuver. Additional scans of the spermatic cord in the region of the scrotal neck and inguinal canal region were obtained in special circumstances: Undescended testis, encysted hydrocele of cord, and varicocele.During the ultrasound scan, on a routine basis, all parameters were evaluated. All the records were entered in MS Excel and analyzed by SPSS version 19 on windows format for calculation of descriptive parameters.
A total of n=50 cases were examined from various age groups out of which n=5 cases were from age group 11 -20 years, n=13 were from age group 21 -30 years, n=12 cases were from age group 31 -40 years, n=10 cases from age group 41 -50 years and n=5 cases each from 51 -60 years and 61 -70 years respectively. The mean age group was 35.5 years. Various clinical presentations as depicted in table-2Most of the cases are Clinically presented with a combination of multiple symptoms.Combination: Commonest clinical presentation wasscrotal swelling, as in n=18 cases (36%).Out of which n=30(60%) were unilateral and n=20(40%) werebilateral.Combination of pain, swelling, and fever in four cases (8%).The n=30 unilateral swelling showed n=14 cases of right-side involvement and n=16 cases of left-side involvement. The different pathologies detected in the cases have been given in table 3. Of n=5 cases of congenital anomaly associated with the descent of testes, n=2 cases were referred with clinical suspicion of incompletely descended testes, which were clinically palpable. All were unilateral in the presentation. Age of presentation varied from 2 Years to 26 years, with a median age of 3 years. The size of undescended testes was found to be smaller in cases, which presented clinically in later stages.In the present study, 4% of cases of scrotal and testicular trauma were detected. The etiology of trauma included sports injury in 1 case, road traffic accident in 1 case. Both are unilateral, out of n=1 cases on the right side and n=1 cases were on the left side.Among non-neoplastic scrotal swellings, hydrocele is the commonest pathology noted in n=9 cases. Epididymal cyst in n=2 cases, varicocele in n=6 cases. In our study, out of n=50 cases, n=16 cases were detected to have inflammatory scrotalpathology on highfrequency US and Doppler study. Chronic Epididymo orchitis was the commonest inflammatory pathology detected, noted in n=5 cases. Next, the most frequentinflammatory pathology detected was acute Epididymo orchitis, noted in n=4 cases.
The superficial location of the scrotal contents makes them ideally suited for sonographic examination. The development of high-frequency, real-time scanners has enhanced the diagnostic accuracy of scrotal sonographic examinations. Scrotal ultrasound has reached a level of maturity that allows the technique to be the first and only imaging examination necessary to evaluate the scrotal contents.In this study, out of n=50 cases, n=16 cases were detected to have inflammatory scrotal pathology on highfrequency US and Doppler study. Chronic Epididymo orchitis was the commonest inflammatory pathology detected, noted in n=5 cases. Next, the most frequent inflammatory pathology detected was acute Epididymo orchitis, noted in n=4 cases. PH Arger et al;
Within the limitations of the present study, we can conclude that ultrasonography is best for the demonstration of morphological changes due to acute scrotal inflammation. The color doppler sonography can accurately differentiate between testicular ischemia and torsion from acute inflammatory diseases. High-frequency ultrasonography with Doppler is highly sensitive in demonstrating the varicoceles. MRI provides better delineation of borders, cystic components, and tissue signal intensities of the testicular masses. Thus,useful for further characterization of testicular masses. CT is the imaging modality of choice for detecting metastatic deposits