Benign Intra Scrotal Cystic Lesions

Benign intrascrotal lesions are common in clinical practice and recognition is important to avoid surgical intervention. We summarize important ultrasound features of benign intrascrotal lesions including intratesticular lesions (tunica albuginea cysts, testicular simple cysts, epidermoid cysts, cystic ectasia of the rete testis, intratesticular varicocele, abscess and paratesticular lesions (cystadenomas, spermatoceles, hydroceles, varicoceles). The sonographic appearence of hydrocele are fluid collections confined to antero lateral portions of scrotum. Hematocele and pyoceles are less common and contain internal echoes and loculations. Both epididymal cysts and spermatoceles have similar sonographic features. Spermatoceles are usually noted in head of epididymis where as epididymal cysts arise from throughout the length of epididymis. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. The sonographic appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. The sonographic findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Papillary cystadenomas of epididymis may be seen in patients with Von Hippel Lindau disease. Improvements in high resolution of US technology allow subtle differences between scrotal lesions. This review provides the reader with a better understanding of cystic lesions that occur in the scrotum.