No abstract

The use of high-resolution real-time ultrasound is becoming more widespread as a technique for evaluation of scrotal contents. Testicular versus extratesticular origins of pathology as well as cystic versus solid lesions can be distinguished with a high degree of accuracy. We report a case of benign epididymal mass simulating an intratesticular tumor. CASE REPORTA 39-yr-old man was evaluated for recurrent left testicular swelling and pain following testicular trauma two years before presentation. There were no urinary symptoms, and evidence of systemic disease was absent. Several courses of antibiotics resulted in the temporary relief of symptoms.On physical examination there was a firm, enlarged, and mildly tender epididymis, but no palpable testicular mass. The opposite epididymis was also firm and slightly prominent, but nontender. All laboratory data were normal. The patient was referred to our ultrasound laboratory for evaluation.A high-resolution real-time sonogram was obtained using a dedicated small-parts scanner (Picker Microview) with a nominal transducer frequency of either 8 or 10 MHz. The mechanical linear-motion transducer is housed within an adjustable, self-contained water bath. A digital scan converter allows both pre-and postprocessing data manipulation. The real-time technique allows a complete survey of scrotal contents. The patient was placed in a supine position, with the scrotum placed on a drape and stabilized with the operator's free hand. Longitudinal and transverse scans showed an enlarged left epididymis with a reactive hydrocele. At the lower pole of the left testis was a 0.7-cm hypoechoic, solid mass (Fig lA, B). A prominent epididymis was demonstrated in the right testis, which was otherwise normal.Since the ultrasound examination revealed a solid, hypoechoic mass, felt t o be consistent with a n intratesticular neoplasm, the patient underwent a left radical orchiectomy through an inguinal approach. The operative procedure involves removal of the spermatic cord to the level of the inguinal ring without extensive lymph node dissection. Following orchiectomy, the testis and epididymis were sagittally incised. Although the testis itself appeared normal, there was a pale, firm, nodular thickening measuring approximately 1 cm in diameter located in the lower pole of the epididymis (Fig 2). This nodule consisted of fibrous connective tissue with several welldemarcated necrotizing granulomas. This nodule invaginated the lower pole of the left testis.Microscopically, there were only occasional multinucleated giant cells along the periphery of the granulomas, and in the necrotic centers a few degenerated spermatozoa were found. Stains for fungi, acid-fast organisms, and spirochetes were negative. It was concluded that the lesion represented a sperm granuloma that had involved the epididymis and the edge of the body of the testis. The surgical specimen was rescanned, and a hypoechoic, apparently intratesticular mass was again demonstrated (Fig 3). A metallic pin used as a sonographic marker w...

Ultrasound has become more and more widespread in the diagnosis of breast disease. However, opinions still diverge concerning its exact place in the diagnosis of breast cancer. An understanding and awareness of the principal pitfalls and limitations of this modality is essential for its optimum and responsible usage. An analysis of four interesting cases illustrates the benefits and limitations of this technique.