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Role of ultrasound in the diagnosis of testicular lesions

Phillip FC Lung and Paul S Sidhu

Ultrasound is the main imaging technique in the assessment of the scrotal contents, providing unparalleled imaging of exquisite resolution. Ultrasound is effectively the sole scrotal imaging technique that a patient will undergo prior to definitive surgery. The accurate assessment of focal intratesticular lesions in the adult patient is of paramount importance, although most focal lesions will be malignant and require an orchidectomy, the recognition of the benign entity is essential to the individual patient. This article covers the salient features of benign and malignant focal intratesticular lesions to allow a confident diagnosis and to prevent unnecessary orchidectomy. We detail the range of intratesticular malignancies from germ cell tumors to lymphoma and metastases. Operator confidence is necessary to establish a benign diagnosis and we highlight important benign lesions that may benefit from a ‘watch and wait’ policy, such as infarction, abscess formation, focal orchitis, rete testis; as well as more bizarre unusual pathologies: intratesticular varicocele and adrenal rest tumors to name but a few. New ultrasound imaging techniques will be reviewed and their role discussed.