E3319. Beyond the Testicle: Diagnosing the Extratesticular Scrotal Mass - A Sonographic Review
  1. Kathleen Brindle; The George Washington University Medical Center
  2. Nadia Khati; The George Washington University Medical Center
Ultrasound (US) is the imaging modality of choice for the initial assessment of a potential scrotal mass given its low cost, ready availability, lack of ionizing radiation and high sensitivity in detection of lesions. One of the first steps in characterization of a scrotal mass is localization of the lesion to the testicle itself or to the extratesticular spaces and/or soft tissues. Although most intratesticular masses are considered malignant until proven otherwise, extratesticular masses can be more challenging to diagnose given the complex anatomy of the paratesticular scrotal space and a broad differential diagnosis that includes both benign and malignant lesions. Familiarity with the lesions that can occur in the extratesticular space may allow a definite diagnosis in some cases or confirm the necessity for additional imaging or biopsy in other cases.

Educational Goals / Teaching Points
The goal of this educational exhibit is to increase the confidence of radiology learners when encountering a mass in the extratesticular space on US imaging. It will begin with an anatomic review of the extratesticular space followed by various case-based examples to illustrate the gamut of both benign and malignant entities that can affect this area. Additional imaging and management of these lesions will also be discussed when appropriate.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The anatomic structures that compose the extratesticular space including the epididymis, spermatic cord, and various fascial layers will be reviewed. Sonographic cases with pathologic involvement of the anatomic structures will be presented and will encompass both cystic and solid masses as well as pseudomasses. Correlation with other imaging modalities will be provided where available.

Extratesticular scrotal masses are frequently encountered on US examinations. Though frequently benign, malignancies and nonneoplastic conditions can also occur. Knowledge of the paratesticular scrotal anatomy and characteristic sonographic findings of many of these lesions can help narrow the differential diagnosis and guide decision making that may include additional imaging, biopsy, and surgery.