Acute epididymitis can lead to obstruction of the adjacent testicular blood supply, resulting in focal or diffuse infarction of the testis or epididymis in the absence of torsion. Four cases are presented to demonstrate the spectrum of B-scan ultrasound findings, ranging from focal necrosis of the epididymis and ischemic infarction of the testis to diffuse testicular infarction. Epididymal enlargement and skin thickening are consistently seen on ultrasound as well as swelling and decreased echogenicity of the testicle. The authors suggest a protocol for acute scrotal symptoms, incorporating clinical findings and (where appropriate) radionuclide scans.

Testicular torsion was evaluated by B-scan ultrasound in one experimental animal and in 12 patients. The clinical findings were categorized as acute, subacute, or chronic depending on the amount of time that had elapsed since the onset of pain (less than 24 hours, 1 to 10 days, and more than 10 days, respectively). A consistent pattern of sonographic parenchymal changes for each of these stages is described. The ultrasound textural changes were found to be diagnostically useful when correlated with the clinical findings. Scrotal ultrasound also complements radioisotope studies, locating the testicle when it cannot be found by palpation, and may detect testicular torsion that is not suspected clinically. When physiologic blood flow studies are normal in the clinical setting of possible torsion, ultrasound is more accurate than other imaging modalities in demonstrating pathology.

Eight scrotal masses which appeared homogeneously hyperechoic on ultrasound were studied; 5 were testicular and 3 were extratesticular. Pathologically, there was no evidence of malignancy, and most lesions consisted of scar tissue or fibrosis. Two benign adenomatoid tumors were encountered. In this series, a homogeneously hyperechoic scrotal lesion was benign regardless of its location.

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Using ultrasound (US), we studied seven patients with torsion of the spermatic cord associated with a large amount of extratesticular hemorrhage. In each case, US showed a large echogenic or complex extratesticular mass caused by the hemorrhage, in addition to a hypoechoic testis and scrotal skin thickening. This appearance should be recognized as part of the spectrum of sonographic appearances that can be seen in torsion.