Extratesticular Cystic Mass



Extratesticular Cystic Mass


Bhawan K. Paunipagar, MD, DNB

Michael P. Federle, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Hydrocele


  • Varicocele


  • Spermatocele


  • Epididymal Cyst


  • Tubular Ectasia of Rete Testis


Less Common



  • Tunica Albuginea Cyst


  • Hematocele, Acute


  • Pyocele


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Hydrocele



    • Congenital or acquired


    • Fluid collection in the tunica vaginalis


    • Envelopes testis except for the “bare area” where the tunica vaginalis is deficient


  • Varicocele



    • Dilation of veins of pampiniform plexus > 2-3 mm in diameter due to retrograde flow in internal spermatic vein


    • Dilated serpiginous veins behind superior pole of testis on color Doppler US, the best imaging tool


    • Enlarge with Valsalva maneuver


  • Spermatocele



    • Retention cyst of tubules connecting rete testis to head of epididymis


    • Located in head of epididymis; contains spermatozoa


    • Large spermatoceles have low-level echoes and septations


  • Epididymal Cyst



    • Located in epididymal head, body, tail; shows all features of a simple cyst


    • Anechoic, does not contain spermatozoa


  • Tubular Ectasia of Rete Testis



    • Normal variant of dilated seminiferous tubules in mediastinum of testis


    • Intratesticular but dilation often associated with spermatocele, giving appearance of a complex intra/extratesticular mass


    • No flow on color Doppler


Helpful Clues for Less Common Diagnoses



  • Tunica Albuginea Cyst



    • Located within the layers of tunica albuginea


    • Usually solitary but can be multiple; 2-3 mm diameter


    • Asymptomatic


  • Hematocele, Acute



    • Associated with trauma, torsion and infarction


    • Varies in appearance with evolution of blood products


    • Look for associated testicular injury


  • Pyocele



    • Sequela of scrotal infections


    • Septate fluid with low-level internal echoes


    • Chronicity may lead to thickening of the tunica and the scrotal wall






Image Gallery









Longitudinal ultrasound of scrotum shows anechoic fluid image within the tunica vaginalis, indicative of a simple hydrocele. Fluid in the tunica vaginalis envelopes the testis except posteriorly image, where it is deficient.
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Aug 2, 2016 | Posted by in GENERAL | Comments Off on Extratesticular Cystic Mass
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