Extratesticular Solid Mass



Extratesticular Solid Mass


Bhawan K. Paunipagar, MD, DNB

Michael P. Federle, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Epididymitis


  • Hematocele, Chronic


  • Inguinal Hernia


  • Scrotal Pearl


  • Adenomatoid Tumor


  • Fibrous Pseudotumor


Less Common



  • Mesenchymal Tumors, Scrotum


  • Papillary Cystadenoma, Epididymis


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Clinical presentation + US findings key


Helpful Clues for Common Diagnoses



  • Epididymitis



    • Increase or decrease in echogenicity depending upon acute or chronic stage


    • Enlarged, hyperemic epididymis and/or testis on color Doppler US


    • Compare with contralateral side


  • Hematocele, Chronic



    • Associated with trauma, torsion, infarct


    • Complex echogenic fluid



      • May be chronic and fibrotic, appearing as a solid mass


    • No intrinsic vascularity demonstrable


    • Ipsilateral testis should be separately identified to exclude injury


  • Inguinal Hernia



    • Inguino-scrotal hernia; indirect type


    • Bowel or echogenic omental fat seen within scrotum



      • Important to identify vascularity of bowel to exclude strangulation


  • Scrotal Pearl



    • Detached and calcified testicular appendages post-inflammatory or secondary to prior torsion


  • Adenomatoid Tumor



    • Most common epididymal tumor



      • 30% of all extratesticular neoplasms


    • Well-defined, solid, hypoechoic mass


    • Peripheral vascularity on color Doppler


  • Fibrous Pseudotumor



    • Reactive fibrous proliferation, usually associated with tunica albuginea


    • Generally hypoechoic with strong posterior shadowing


    • Can be as large as 8 cm in diameter


Helpful Clues for Less Common Diagnoses



  • Mesenchymal Tumors, Scrotum



    • Lipoma most common benign neoplasm



      • Often appear hypoechoic


    • Most common malignant tumors include rhabdomyosarcoma and liposarcoma



      • Large, irregular, heterogeneous masses


  • Papillary Cystadenoma, Epididymis



    • Epididymal component of the von Hippel-Lindau syndrome



      • Seen in 65% of patients with VHL


    • Often bilateral; found in young adults


    • Ill-defined solid mass with scattered cysts






Image Gallery









Longitudinal color Doppler ultrasound shows an enlarged and hyperemic epididymis image in a man who reported 2 days of scrotal pain and swelling.
Only gold members can continue reading. Log In or Register to continue

Related Posts

Aug 2, 2016 | Posted by in GENERAL | Comments Off on Extratesticular Solid Mass
Premium Wordpress Themes by UFO Themes