Radiological imaging of the scrotal diseases.

Dr/ ABD ALLAH NAZEER. MD.

OUTLINE:Anatomy.Imaging.Congenital diseases.Inflammatory diseases.Scrotal trauma.Testicular torsion.Testicular masses.Extra-testicular pathology.Miscellaneous.

Anatomy of the ScrotumAnatomic structures include:TestisEpididymisVas deferensVenous plexusTesticular arteryAppendix of epididymis (remnant from embryogenesis)Appendix of testis (remnant from embryogenesis)

Anatomy of the Scrotum:Layers include(Testis: Seminiferous tubules)Tunica albugineaVisceral layer of Tunica vaginalisParietal layer of Tunica vaginalisFasciaDartos muscleSkin

Cryptorchidism (derived from the Greek kryptos, meaning hidden, orchis, meaning testicle) is the absence of one or both testes from the scrotum. It is a common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life (the majority within three months), making the true incidence of cryptorchidism around 1% overall. Cryptorchidism is distinct from monorchismm, the condition of having only one testicle.A testis absent from the normal scrotal position can be:found anywhere along the "path of descent" from high in the posterior (retroperitoneal) abdomen, just below the kidney, to the inguinal ring; found in the inguinal canal; ectopic, that is, found to have "wandered" from that path, usually outside the inguinal canal and sometimes even under the skin of the thigh, the perineumm, the opposite scrotum, or the femoral canal;found to be undeveloped (hypoplastic) or severely abnormal (dysgenetic);found to have vanished (also see anorchia).

Congenital anomalies of the testis.

About two thirds of cases without other abnormalities are unilateral; one third involve both testes. In 90% of cases an undescended testis can be felt in the inguinal canal; in a minority the testis or testes are in the abdomen or nonexistent (truly "hidden").Undescended testes are associated with reduced fertility, increased risk of testicular germ cell tumors and psychological problems when the boy is grown. Undescended testes are also more susceptible to testicular torsion and infarction and inguinal hernias. "Usually the testicle will descend into the scrotum without any intervention during the first year of life, but to reduce these risks, undescended testes can be brought into the scrotum in infancy by a surgical procedure called an orchiopexy.Although cryptorchidism nearly always refers to congenital absence or maldescent, a testis observed in the scrotum in early infancy can occasionally "reascend" (move back up) into the inguinal canal. A testis which can readily move or be moved between the scrotum and canal is referred to as retractile.

Cryptorchidism with inguinal canal and intra-abdominal testis

Cryptorchidism with undescended testicle in the right inguinal canal

Cryptorchidism. Coronal image shows a nondescended testis in the right inguinal canal of a child

Axial contrast-enhanced CT image shows fluid collection with gas in the right scrotum, corresponding to an abscess.

Axial contrast-enhanced CT image shows right inguinal tubular structures with contrast enhancement corresponding to a varicocele.

Axial contrast-enhanced CT image shows a right fluid inguino-scrotal collection corresponding to hydrocele.

Spermatic cord lipoma.

Liposarcoma. Axial T1-weighted fat-supressed and contrast-enhanced image shows enhancement of the solid non-fatty components of the tumor.

Liposarcoma. Coronal T2-weighted (a), axial T2-weighted (b), axial T1-weighted (c) and T2-weighted fat-supressed images show right inguino-scrotal mass with heterogeneous signal intensity.

Axial contrast-enhanced CT image shows bilateral inguinal cystic metastases of epidermoid carcinoma of the penis.

Thank You.