Veins of pampiniform plexus : at rest

varicocele seen on ValsalvaVeins dilated on Valsalva maneuver

ultrasound image of varicoceleMeasuring the vein diameter

 Scrotal varicocele is an abnormal dilatation of the veins draining the testes, namely the pampiniform plexus. These images show an early varicocele, typically involving the left side with characteristic increase in diameter of vessels on Valsalva maneuver. Color Doppler is crucial in visualizing details of the affected veins. These ultrasound/color doppler images of varicocele are courtesy of Dr. Vikas Arora, Firozepur, India.

Large varicocele:

sonographic image of large varicocele

color doppler image showing a huge varicocele

image of a really large varicocele

 These sonographic images (B-mode) and color doppler imaging, show a huge varicocele of the left side of scrotum. Diameter of the veins measured a maximum of 8.2mm. Color Doppler images of the varicocele, leave little to the imagination. Case and ultrasound images courtesy of Dr. Ravi Kadasne, Radiologist, UAE.

Intratesticular varicocele:

ITV seen as anechoic tubular lesion, centrally.

Spectral doppler imaging- reversal of flow, Valsalva.


We present ultrasound images of a case of intratesticular varicocele (ITV) associated with extratesticular varicocele (ETV).

Varicoceles are usually extratesticular. But recently, intratesticular varicoceles (ITV) have also been reported in medical literature. The typical ITV may be subcapsular or central in location . They usually communicate with the associated extratesticular varicocele. Color Doppler sonography shows a typical anechoic tubular structure in the central part of the testes, showing venous spectral flow pattern. Valsalva maneuver shows augmentation of the flow. These images show communication between the ITV and ETV.

The important differential diagnosis is tubular ectasia of the rete testes. Color flow imaging will be useful, here. 

Case and sonographic images courtesy of Dr. Ravi Kadasne, MD, UAE.

References: (both full-text articles are free)



For more ultrasound images and sonographic pictures of the scrotum see:


Acute epididymo-orchitis:

The right testes is swollen

Increased vascularity (testes on fire)

testes on fire

 (Images courtesy of Dr. Vikas Arora, Ferozepur, India)

Inflammation of the testes and the epididymis can present as an acute scrotum. We present a case of acute Right epididymo-orchitis. Ultrasound scan is an excellent method of evaluating such cases. The following typical findings are seen here:

1)      swollen right testes and epididymis

2)      increased vascularity of the testes on color Doppler study; also the capsular and centripetal vessels are well seen; (testes on fire). The vascular markings are also well seen on grey scale imaging.

3)      scrotal wall edema

4)      small right hydrocele with septae. 

The important differential diagnosis here is torsion of the testes.

Reference: (the entire article is free).

For more on the acute scrotum see:

Hydrocele and pyocele:

Hydrocele is an abnormal collection of fluid, usually serous, between the the two layers of the tunica vaginalis covering the testes. It may be congenital or acquired. Hydrocele is easily diagnosed by ultrasound scan. A pyocele is the same as a hydrocele, but has purulent fluid within it. Hematocele is a hydrocele with blood within the fluid and almost always is the result of trauma. Both pyoceles and hematoceles contain multiple septae within the fluid collection. The images below represent a septate collection, possibly a pyocele, and a large one at that, involving the right side.

     References:1) Scrotal Abscess (Pyocele)

                                                                                     2) The traumatized scrotum. Ultrasound evaluation - group of 3 »