Ultrasonography of the scrotum: Extratesticular

Extratesticular lesions are mostly benign. Adenomatoid tumor of the epididymis is the most common solid extratesticular tumor. Differentiating between a spermatocele and an epididymal cyst is not clinically relevant. Sperm granuloma is an entity to consider more strongly in patients with previous vasectomy. When evaluating a suspected palpable lesion with ultrasonography, the examiner should palpate the lesion to ascertain firmness and help direct the examination. By virtue of the ascending nature of the infection, epididymitis may be limited to the epididymal tail, so sonographic evaluation of suspected acute epididymitis must carefully evaluate this region. Evaluation of suspected hernias and varicoceles usually requires provocative maneuvers; having the patient do a Valsalva maneuver may be sufficient, but in some cases upright positioning will be needed to better demonstrate the abnormality.