Imaging Scrotal Lumps in Adults-2: Cysts and Fluid Collections

Abstract

Scrotal cystic lesions and fluid collections are common incidental findings at ultrasonography performed in symptomatic and asymptomatic men. The majority of cystic lesions are located in the epidydimis, but the testis and the cord are frequently involved. Testicular, albugineal and epidermoid cysts, cystic dysplasia of the rete testis, cysts of the spermatic cord, and cystic appendages are easily detected at ultrasound, which is the method of choice in assessing any fluid containing mass, providing detailed information at high resolution. Magnetic resonance (MR) imaging is a second line procedure and can be used as a problem-solving tool when ultrasound findings are equivocal. Most fluid collections are located in the vaginal sac and can be idiopathic or secondary to trauma, inflammation, or tumor. Ultrasound findings in combination with clinical assessment are generally sufficient for the final diagnosis, and MR imaging is rarely employed. In this chapter ultrasound and MR appearance of the scrotal cystic lesions and fluid collections are described and differential diagnoses discussed.