Ciara O'Brien;
University Health Network; University of Toronto
Darragh Halpenny;
Tallaght University Hospital
William Torreggiani;
Tallaght University Hospital
Background
A wide variety of traumatic and nontraumatic testicular pathology exists. Patient's with more chronic/subacute pathology may present acutely with acute complications. Ultrasound is the mainstay of evaluation of testicular pathology, providing a quick and safe means of diagnostic assessment.
Educational Goals / Teaching Points
We review normal variants of the testes that are commonly encountered in practice and occasionally mistaken for pathology.
We also review typical features of testicular neoplasms as well as reviewing more frequently encountered paratesticular lesions.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A knowledge of normal variant anatomy of the testes is critical. Such findings include tubular ectasia of the rete testis. We also review "don't touch" testicular/paratesticular lesions such as epidermoids. Avoiding over-investigation and over-treatment when there are characteristically benign imaging findings is paramount to reduce patient anxiety and avoid wasteful use of resources. For symptomatic patients, the contralateral testis should always be imaged for completeness, as we highlight in our cases. We highlight the importance of assessment of paratesticular structures which should be undertaken as routine with all scrotal ultrasound studies, which is of particular importance in symptomatic patients when the testes are normal. Many primary testicular malignant tumors have a relatively short doubling time (10 - 30 days in some cases), compared to other solid organ malignancy. Where a testicular lesion is considered radiologically indeterminate, initial short-interval ultrasound follow-up should be considered. The testes can be involved in systemic disorders such as lymphoma or sarcoidosis. These conditions may be diagnosed subsequent to testicular imaging. Radiologists play an important role in recommending appropriate next-step imaging, most frequently in the form of CT chest or CT chest, abdomen/pelvis. Historic cross-sectional imaging, where available, should also be reviewed when interpreting testicular ultrasound studies and may be crucial if there is diagnostic uncertainty.
Conclusion
A wide variety of testicular pathology exists. The testes can be primarily or secondarily involved by disease. Ultrasound remains the mainstay first line imaging modality for evaluation of testicular pathology.
