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CEUS Scrotum: Diffuse Disease
Vasileios Rafailidis, MD, MSc, PhD, EDiR; Dean Huang, FRCR, EBIR; Paul S. Sidhu, BSc, MBBS, MRCP, FRCR, DTM&H
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • In testicular rupture, tunica albuginea is disrupted and parts of testicular parenchyma may be extruded within hemiscrotum
        • Testicular fracture refers to presence of at least 1 fracture line crossing testicular parenchyma with intact tunica albuginea
        • Inflammation of epididymis and testis are termed epididymitis and orchitis or epididymoorchitis in cases of combined disease
        • Testicular lymphoma may either be primary in 84% of cases or secondary site of disease involvement in 16% of patients
        • Testicular leukemia can be seen in patients during and after acute leukemia

      PATHOLOGY

      • General Features

        IMAGING

        • General Features

          • US Findings

            • CEUS Findings

              DIAGNOSTIC CHECKLIST

              • Trauma

                • Inflammatory Conditions

                  • Lymphoma and Leukemia

                    Selected References

                    1. Sidhu PS et al: The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall Med. 39(2):e2-e44, 2018
                    2. Rafailidis V et al: Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound. Ultrasound. 24(1):23-33, 2016
                    3. Bertolotto M et al: Grayscale and color Doppler features of testicular lymphoma. J Ultrasound Med. 34(6):1139-45, 2015
                    4. Yusuf G et al: Multiparametric sonography of testicular hematomas: Features on grayscale, color Doppler, and contrast-enhanced sonography and strain elastography. J Ultrasound Med. 34(7):1319-28, 2015
                    5. Joel J et al: Testicular sarcoidosis masquerading as testicular carcinoma. Cent European J Urol. 67(3):261-3, 2014
                    6. Tsili AC et al: MR imaging of scrotum. Magn Reson Imaging Clin N Am. 22(2):217-38, vi, 2014
                    7. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                    8. Hedayati V et al: Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage. Br J Radiol. 85(1011):e65-8, 2012
                    9. Huang DY et al: Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. Br J Radiol. 85 Spec No 1:S41-53, 2012
                    10. Lung PF et al: Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epididymitis. AJR Am J Roentgenol. 199(3):W345-54, 2012
                    11. Mirochnik B et al: Ultrasound evaluation of scrotal pathology. Radiol Clin North Am. 50(2):317-32, vi, 2012
                    12. Yagil Y et al: Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 29(1):11-21, 2010
                    13. Kim SH et al: The efficacy of magnetic resonance imaging for the diagnosis of testicular rupture: a prospective preliminary study. J Trauma. 66(1):239-42, 2009
                    14. Moschouris H et al: Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography? Int Braz J Urol. 35(6):692-702; discussion 702-5, 2009
                    15. Guichard G et al: Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology. 71(1):52-6, 2008
                    16. Deurdulian C et al: US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics. 27(2):357-69, 2007
                    17. Kim SH et al: Significant predictors for determination of testicular rupture on sonography: a prospective study. J Ultrasound Med. 26(12):1649-55, 2007
                    18. Kim W et al: US MR imaging correlation in pathologic conditions of the scrotum. Radiographics. 27(5):1239-53, 2007
                    19. Buckley JC et al: Diagnosis and management of testicular ruptures. Urol Clin North Am. 33(1):111-6, vii, 2006
                    20. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42 (2): 349-63, 2004
                    21. Woodward PJ et al: From the archives of the AFIP: tumours and tumorlike lesions of the testis:radiologic-pathologic correlation. Radiographics. 22(1):189-216, 2002
                    22. Cook JL et al: The changes seen on high-resolution ultrasound in orchitis. Clin Radiol. 55(1):13-8, 2000
                    23. Eskey CJ et al: Malignant lymphoma of the testis. AJR Am J Roentgenol. 169(3):822, 1997
                    24. Mazzu D et al: Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR Am J Roentgenol. 164(3):645-7, 1995
                    25. Phillips G et al: Ultrasonic evaluation of the scrotum in lymphoproliferative disease. J Ultrasound Med. 6(4):169-75, 1987
                    26. Subramanyam BR et al: Diffuse testicular disease: sonographic features and significance. AJR Am J Roentgenol. 145(6):1221-4, 1985
                    Related Anatomy
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Imaging

                        TERMINOLOGY

                        • Definitions

                          • In testicular rupture, tunica albuginea is disrupted and parts of testicular parenchyma may be extruded within hemiscrotum
                          • Testicular fracture refers to presence of at least 1 fracture line crossing testicular parenchyma with intact tunica albuginea
                          • Inflammation of epididymis and testis are termed epididymitis and orchitis or epididymoorchitis in cases of combined disease
                          • Testicular lymphoma may either be primary in 84% of cases or secondary site of disease involvement in 16% of patients
                          • Testicular leukemia can be seen in patients during and after acute leukemia

                        PATHOLOGY

                        • General Features

                          IMAGING

                          • General Features

                            • US Findings

                              • CEUS Findings

                                DIAGNOSTIC CHECKLIST

                                • Trauma

                                  • Inflammatory Conditions

                                    • Lymphoma and Leukemia

                                      Selected References

                                      1. Sidhu PS et al: The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall Med. 39(2):e2-e44, 2018
                                      2. Rafailidis V et al: Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound. Ultrasound. 24(1):23-33, 2016
                                      3. Bertolotto M et al: Grayscale and color Doppler features of testicular lymphoma. J Ultrasound Med. 34(6):1139-45, 2015
                                      4. Yusuf G et al: Multiparametric sonography of testicular hematomas: Features on grayscale, color Doppler, and contrast-enhanced sonography and strain elastography. J Ultrasound Med. 34(7):1319-28, 2015
                                      5. Joel J et al: Testicular sarcoidosis masquerading as testicular carcinoma. Cent European J Urol. 67(3):261-3, 2014
                                      6. Tsili AC et al: MR imaging of scrotum. Magn Reson Imaging Clin N Am. 22(2):217-38, vi, 2014
                                      7. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                      8. Hedayati V et al: Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage. Br J Radiol. 85(1011):e65-8, 2012
                                      9. Huang DY et al: Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. Br J Radiol. 85 Spec No 1:S41-53, 2012
                                      10. Lung PF et al: Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epididymitis. AJR Am J Roentgenol. 199(3):W345-54, 2012
                                      11. Mirochnik B et al: Ultrasound evaluation of scrotal pathology. Radiol Clin North Am. 50(2):317-32, vi, 2012
                                      12. Yagil Y et al: Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 29(1):11-21, 2010
                                      13. Kim SH et al: The efficacy of magnetic resonance imaging for the diagnosis of testicular rupture: a prospective preliminary study. J Trauma. 66(1):239-42, 2009
                                      14. Moschouris H et al: Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography? Int Braz J Urol. 35(6):692-702; discussion 702-5, 2009
                                      15. Guichard G et al: Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology. 71(1):52-6, 2008
                                      16. Deurdulian C et al: US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics. 27(2):357-69, 2007
                                      17. Kim SH et al: Significant predictors for determination of testicular rupture on sonography: a prospective study. J Ultrasound Med. 26(12):1649-55, 2007
                                      18. Kim W et al: US MR imaging correlation in pathologic conditions of the scrotum. Radiographics. 27(5):1239-53, 2007
                                      19. Buckley JC et al: Diagnosis and management of testicular ruptures. Urol Clin North Am. 33(1):111-6, vii, 2006
                                      20. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42 (2): 349-63, 2004
                                      21. Woodward PJ et al: From the archives of the AFIP: tumours and tumorlike lesions of the testis:radiologic-pathologic correlation. Radiographics. 22(1):189-216, 2002
                                      22. Cook JL et al: The changes seen on high-resolution ultrasound in orchitis. Clin Radiol. 55(1):13-8, 2000
                                      23. Eskey CJ et al: Malignant lymphoma of the testis. AJR Am J Roentgenol. 169(3):822, 1997
                                      24. Mazzu D et al: Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR Am J Roentgenol. 164(3):645-7, 1995
                                      25. Phillips G et al: Ultrasonic evaluation of the scrotum in lymphoproliferative disease. J Ultrasound Med. 6(4):169-75, 1987
                                      26. Subramanyam BR et al: Diffuse testicular disease: sonographic features and significance. AJR Am J Roentgenol. 145(6):1221-4, 1985