RadteraUltrasound Scrotal / Testicular
USNo contrastAbdomen & Pelvis
Indications
- Scrotal pain (rule out torsion)
- Palpable scrotal mass
- Suspected epididymo-orchitis
- Trauma
- Suspected varicocele/hydrocele
- Infertility evaluation
- Undescended testis / follow-up
Patient prep
- None
- Supine with penis on abdomen and scrotum supported by towel; warn re cold gel
Contrast
None / non-contrast
Technique
- High-frequency linear transducer 7-15 MHz
- Grayscale of both testes in long and transverse with side-by-side comparison view
- Color and spectral Doppler MANDATORY to assess testicular flow (symmetric settings)
- Valsalva / upright imaging for varicocele
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Right testis | Long axis and transverse | Measure 3 dimensions; echotexture |
| 2 | Left testis | Long axis and transverse | Measure 3 dimensions; echotexture |
| 3 | Side-by-side comparison (both testes one image) | Transverse | Compare echogenicity and color flow symmetry |
| 4 | Right epididymis (head/body/tail) | Long axis | Size, vascularity |
| 5 | Left epididymis (head/body/tail) | Long axis | Size, vascularity |
| 6 | Testicular color and spectral Doppler | Both testes | Document arterial flow; assess for absent flow (torsion) or hyperemia (orchitis) |
| 7 | Scrotal sac / extratesticular space | As needed | Hydrocele, hernia, varicocele (with Valsalva) |
Key points
- Color/spectral Doppler is required — absent or reduced intratesticular flow indicates torsion (surgical emergency)
- Always obtain a side-by-side transverse comparison of both testes for echotexture and flow symmetry
- Hyperemia with reactive hydrocele suggests epididymo-orchitis
- Varicocele: dilated pampiniform veins >2-3 mm that increase with Valsalva/upright position
References
• AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations
• ACR Appropriateness Criteria: Acute Onset of Scrotal Pain
• Radiopaedia: Scrotal ultrasound link
• ACR Appropriateness Criteria: Acute Onset of Scrotal Pain
• Radiopaedia: Scrotal ultrasound link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.