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Ultrasound - scrotum

ULTRASOUND - SCROTUM ROLE OF scrotum ULTRASOUND Ultrasoundis essentially used to investigate causes for: Pain Which side? Dull or sharp? Constant or intermittent? Acute or

ملتقى التصوير الطبي ( الأشعة )
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قديم 11-23-2012, 11:08 PM
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عبدالله الشهري will become famous soon enough


ULTRASOUND - SCROTUM





ROLE OF scrotum ULTRASOUND





Ultrasoundis essentially used to investigate causes for:





Pain





Which side?





Dull or sharp?





Constant or intermittent?





Acute or chronic?





Does it travel higher?





Mass





Trauma





Infertility





Undescended testis





H/o Trauma ,surgery or infection?





Reduced Sperm count





Varicocele





Hydrocele





Infections (orchitis,prostatitis)





Polycystic kidney disease





Cryptorchidism





LIMITATIONS





It is recognised that Ultrasound offers little or nodiagnostic information for internal structures such as the cruciate ligaments.Ultrasound is complementary with other modalities, including plain X-ray, CT,MRI and arthroscopy.





EQUIPMENT SELECTION AND TECHNIQUE





Use of a high resolution probe (7-15MHZ) is essentialwhen assessing the internal structures of the scrotum.





Low PRF and high gain colour / power / Dopplercapabilities when assessing vessels of a testis.





Be prepared to change frequency output of probe (orprobes) to obtain accurate length measurements, an overview of pathology andanatomy to each other and adequately assess deeper structures in the abdomen ifnecessary.





SCANNING TECHNIQUE





Use of a high resolution probe (7-15MHZ) is essentialwhen assessing the internal structures of the scrotum.





Low PRF and high gain colour / power / Dopplercapabilities when assessing vessels of a testis.





Be prepared to change frequency output of probe (orprobes) to obtain accurate length measurements, an overview of pathology andanatomy to each other and adequately assess deeper structures in the abdomen ifnecessary.





PATIENT PREPARATION





Mustmake sure the patient as comfortable





Not only is this to put the patient at ease but youwill get more information out of him which will give you better clues as towhat the diagnosis will be.





Using a towel or the patients gown, tuck the penis upover the symphasis to help elevate and immobilize the scrotum





Use warm gel.





Begin with a survey scan transversely down the scrotumto compare echogenicity of the testes.





Scan each side independantly in both longitudinal andtransverse planes.





You may need to apply slight pressure to immobilze thetestis as you scan. However, it is important to scan with minimal pressure tovisualize fluid overlying the testis.





Locate the epididymal head and follow in transversedown the body and tail.





Assess both intra and extratesticular structures withpower doppler.





The Valsalva manoeuver or scanning in the uprightposition should be performed when evaluating for varicoceles or hernias.





If a varicocele is identified, the scan should beextended to assess the testicular veins for the point of origin. Such a***tratesticular masses that could be compressing the vein (eg pelviclymphadenopathy)





COMMON PATHOLOGY





Extratesticular Lumpor swelling





Hydrocele





Epididymitis, Orchitis or Epididymo-orchitis





Epididymal Cysts





Varicocele in the Pampiniform plexus





Cryptorchidism or Maldescent





Scrotal "Pearl"





Microlithiasis (intratesticular)





Scrotal swelling with pain





4 main causes:





Torsion (20%)





Infection/inflammation (75-80%)





Haemorrhage





Strangulated Hernia





Torsionresults in acute testicular infarction and eventually an atrophic testicle andconstitutes a medical emergency. Quite often these patients will bypass the imagingdepartment and go straight to theatre.





NOTE:





epididymitis:torsion = 3:2 <20years





epididymitis:torsion = 9:1 >20years





IntratesticularLumps





GermCell Tumours





Seminoma





Nonseminoma





SCROTUM ULTRASOUND SAMPLE PROTOCOL (TYPICALLY)





Thissample protocol is meant for educational purposes and the exact technique willdepend on the patient's clinical indication for the examination and theradiologist's guidance.





A scrotalseries should include the following minimum images;





Transverse image showing both testes for comparitiveechogenicity





Transverse imaging including both testes with colordoppler to show comparative flow.





Transverse images of right testicle.





Vascularity of left testicle





Maximum transverse measurement of right testicle





Longitudinal images of right testicle





Maximum longitudinal measurement of right testicle





Epididymal head and body of right testicle





Spermatic cord of right testicle





Transverse images of left testicle





Vascularity of right testicle





Maximum transverse measurement of left testicle





Longitudinal images of left testicle





Maximum longitudinal measurement of left testicle





Epididymal head and body of left testicle





Spermatic cord of left testicle
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من مواضيعي : عبدالله الشهري
التعديل الأخير تم بواسطة عبدالله الشهري ; 11-23-2012 الساعة 11:17 PM.
  رقم المشاركة : [ 3 ]
قديم 01-03-2013, 02:23 PM
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عبدالله الشهري will become famous soon enough
افتراضي رد: Ultrasound - scrotum

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من مواضيع : عبدالله الشهري
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موضوع مغلق

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الكلمات الدليلية (Tags)
role, scrotum, ultrasound


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