SONOWORLD : Bilateral spermatoceles

Username

Password

189,180 Registered Members as of 10/27/2021.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Pelvis » Scrotum And Testicles

Bilateral spermatoceles

« Back to Listing

Author(s) :

Chaitali Shah, FRCR

Ashok Bhanushali, MD

Presentation A 60 year old man presents with bilateral palpable scrotal masses. He had a vasectomy performed 25 years ago. A scrotal ultrasound was performed.

Caption: Transverse image of the right scrotum.

Description: The right epididymal head appears enlarged and mildly lobular.

Caption: Right oblique image of the scrotum.

Description: Numerous dilated fluid-filled spaces are seen in the region of the epididymal body and tail. The visualized right testis appears normal.

Caption: Transverse image of the right epididymal body.

Description: The rounded fluid filled structures appear to be arising from the epididymus, seen anteriorly in the center on this image. Note the enhanced through transmission beneath the largest cyst.

Caption: Transverse image of the right epididymal tail.

Description: More fluid filled structures are seen in the epididymal tail.

Caption: Color Doppler image of the right epididymis.

Description: No abnormal area of increased vascularity are seen in either the epididymis or testis.

Caption: Transverse left epididymal scan.

Description: The left epididymus also exhibits multiple cystic structures in the epididymal head and body.

Caption: Transverse scan in the upper part of scrotal sac.

Description: The left epididymal body is thickened and has adjacent fluid filled areas. Some of these areas show internal septations.

Caption: Color Doppler of the left epididymal cystic area.

Description: Sparse vascularity is noted around the periphery of the cystic area in the epididymal tail.

Caption: Midline transverse scan of the scrotum.

Description: This image shows the large cystic lesions associated with the epididymi bilaterally.

Differential Diagnosis Bilateral spermatoceles

Final Diagnosis Bilateral spermatoceles.

Discussion

This case is presented to show the ultrasound appearance of a spermatocele.

A spermatocele is a benign clear fluid-filled cyst that may arise in any part of the epididymis and contains non-viable sperm. A spermatocele is usually asymptomatic but sometimes produces palpable masses that may cause discomfort to the patient. It is more common in older men.

No definitive casuative factor for spermatocele has been established. The sperm passes through the epididymis where it undergoes maturation. One theory that has been postulated in the pathogenesis of a spermatocele is that with advancing age, the seminiferous epithelium degenerates and the germ cells that are shed accumulate and block the efferent ducts, resulting in sterile cystic collections within the epididymis.

Ultrasound appearance:
1. Spermatoceles may be single or multiple, unilateral or bilateral.
2. Commonly located in the epididymal head, however they can also be seen in the body and tail.
3. They appear as well-defined hypoechoic or cystic structures that show significant posterior enhancement.
4. Internal septations may be present in the cysts.

Role of ultrasound:
1. To establish a diagnosis and distinguish from other intrascrotal lesions such as a varicocele, hydrocele or a simple epididymal cyst.
2. Ultrasound guided therapeutic aspiration of a multilocular spermatocele may be performed to obtain relief of symptoms.

Case References

Yagi H, Igawa M, Shiina H, Shigeno K, Yoneda T, Wada Y. Multilocular spermatocele: a case report. Int Urol Nephrol. 2001;32(3):413-6.
Nejd F Alsikafi. Spermatocele. http://www.emedicine.com/med/topic2880.htm
Itoh M, Li XQ, Miyamoto K, Takeuchi Y. Degeneration of the seminiferous epithelium with ageing is a cause of spermatoceles? Int J Androl. 1999 Apr;22(2):91-6.

Follow Up

This patient refused any form of treatment and follow up scrotal ultrasound revealed no change in the spermatoceles.

Other contents by this AuthorOther Cases in This Category

Pelvis >> Scrotum And Testicles

Uncomplicated acute epididymo-orchitis
A 25-year-old male, presents with a 1-day history of acute left-sided scrotal pain. He has no history of trauma.

Acute right epididymitis
A 25 year old male presents with a 1 day history of acute right-sided scrotal pain. He has no history of trauma.

Left varicocele
A 25 year old man presents with a dull pain in the left scrotum. There is no history of trauma or fever.

Acute left epididymitis
A 25 year old male, presents with a one day history of acute left-sided scrotal pain. He has no history of trauma.

Complicated acute epididymo-orchitis: with an epididymal abscess
A young adult male presents with a one day history of acute right scrotal pain. There is no history of trauma.

Germ cell tumor testis: NSGCT- embryonal carcinoma
A 32 year old male presents with painless left testicular swelling of 2 months duration. There is no history of trauma or fever.

Germ cell tumor testis:Seminoma
A 30 year old man presents with a painless left testicular swelling. A scrotal ultrasound was performed.

Left testicular and epididymal torsion
A 25 year old man presents with severe, acute left scrotal pain of a few hours duration. The onset was sudden and not preceded by trauma. A scrotal ultrasound was performed.

Epidermoid cyst of the testicle
A 19 year old male presented with a unilateral non tender testicular mass. The patient gives a history of gradual increase in size of the mass. A scrotal ultrasound was performed.

Complicated acute epididymo-orchitis: with testicular infarct
A 30 year old male presented with severe, acute pain in the left scrotum. A scrotal ultrasound was performed.

Germ cell tumor testis: multifocal NSGCT
A 22 year old male presents with left testicular firmness. He has no history of trauma. A scrotal ultrasound was performed.

Tunica albuginea cyst
A 32 year old male presented for a follow up testicular ultrasound. He had an initial scan performed for a palpable left scrotal swelling.

Zinner syndrome
A 32 year old man presented for infertility. Semen analysis revealed oligo-asthenospermia. A scrotal and pelvic scan was performed.

Traumatic testicular rupture with cord hematoma
A young man fell into a well and sustained severe acute blunt injury to the right inguinal region. Clinically he presented with a grossly edematous penis and scrotum. The swelling extended up to ...

Scrotal calculi
A 50 year old doctor with history of repeated self- limiting attacks of excruciating/shooting pain localized to the left testis. The pain subsides after a minute or two. He has no other symptoms

Benign testicular calcification
A 30 year old man presents for infertility evaluation. A scrotal ultrasound was performed.

Scrotal sac hematoma
These are serial ultrasound scans of a young man with a history of trauma to the scrotum.

Leiomyoma of the epididymis
A 59 year-old man presents with two palpable masses in right hemiscrotum. An ultrasound of the scrotum was performed.

Right undescended testis
This is a scan in a 6-month-old male child with an empty right scrotal sac. An ultrasound was performed to locate the undescended testis.

Testicular microlithiasis
This is an incidental finding in a 35-year-old man with dull pain in the scrotum.

Atrophic right testis
This was a follow-up scan in a 35-year-old man with a previous history of right orchitis.

Granulomatous orchitis
This is a scrotal ultrasound scan in a man with complaints of hematuria.

Cystic dilatation of the Rete Testis
A 51-year-old male presents with left scrotal enlargement.

Leydig Cell tumor
An ultrasound evaluation for varicocele was performed on a 10 year old male, with normal blood sub-beta and alpha fetoproteins markers.

Partial Testicular Torsion
A 20 year old male presented to the emergency room with severe left scrotal pain.

Orchitis with abscess formation and hydrocele
54 year old male with scrotal pain and swelling.

Acute idiopathic scrotal edema
5 year old boy with a red painful swollen scrotum

Neonatal extravaginal testicular torsion
Neonate with a scrotal swelling on the right side

Testicular Microlithiasis
This 26 YO male presented for a scrotal ultrasound as an outpatient with no specific medical history on the referral. On questioning he stated that one side of his abdomen was harder and more ...

Testicular Seminoma
A 37-year-old man presents with a complaint of a painless mass in his left testicle. On examination there is testicular enlargement on the left.

Congenital Adrenal Hyperplasia
42 year old male presented with enlargement of both testicles

Leydig Cell Tumor of the Testicle
This is a 35 year-old male patient who presented for presurgical assessment of left Inguinal hernia. Scrotal and inguinal ultrasound was requested.

Bilateral Extravaginal Testicular Torsion
Clinical examination of the neonate revealed a swollen, red and firm scrotum bilaterally. Neither testicle could be individually palpated. No cremasteric reflex observed. No trauma to scrotum ...