Changes

Although the development of new imaging modality such as computerized tomography and magnetic resonance imaging have open a new era for medical imaging, high resolution sonography remains as the initial imaging modality of choice for evaluation of scrotaldisease. Many of the disease processes, such as testicular torsion, epididymo-orchitis, and intratesticular tumor, produce the common symptom of pain at presentation, and differentiation of these conditions and disorders is important for determining theappropriate treatment. High resolution ultrasound helps in better characterize some of the intrascrotal lesions, and suggest a more specific diagnosis, resulting in more appropriate treatments and avoiding unnecessary operation for some of the diseases.<ref name="MakTzeng2012"/>

For any scrotal examination, thorough palpation of the scrotal contents and history takingshould precede the sonographic examination. Patients are usually examined in the supineposition with a towel draped over his thighs to support the scrotum. Warm gel shouldalways be used because cold gel can elicit a cremasteric response resulting in thickening ofthe scrotal wall; hence a thorough examination is difficult to be performed. A highresolution, near-focused, linear array transducer with a frequency of 7.5 MHz or greater isoften used because it provides increased resolutions of the scrotal contents. Images of bothscrotum and bilateral inguinal regions are obtained in both transverse and longitudinalplanes. Color Doppler and pulsed Doppler examination is subsequently performed,optimized to display low-flow velocities, to demonstrate blood flow in the testes andsurrounding scrotal structures. In evaluation of acute scrotum, the asymptomatic sideshould be scanned first to ensure that the flow parameters are set appropriately. Atransverse image including all or a portion of both testicles in the field of view is obtained toallow side-to-side comparison of their sizes, echogenicity, and vascularity. Additional viewsmay also be obtained with the patient performing Valsalva maneuver.<ref name="MakTzeng2012"/>