Scrotal Ultrasound: Updates on Testicular Microlithiasis, Incidental Non-Palpable Lesions, Varicoceles and Testicular Infarction

Ultrasound (US) is the first-line imaging modality when evaluating scrotal pathology. This review will examine some common pathologies that can present diagnostic and clinical ambiguity, including testicular microlithiasis, incidental non-palpable lesions, varicoceles, and testicular infarctions. This review aims to summarize the current literature and evidence-based guidelines for these entities and to describe the important sonographic features for diagnosis as well as discuss associated clinical implications. Current guidelines suggest that management for testicular microlithiasis is dependent on associated patient risk factors and the presence or absence of other findings on ultrasound. Incidental non-palpable lesions are a diagnostic and management challenge and evolving recommendations depend on the size of the lesion and other associated features. Alternatively, varicocele is a relatively straightforward entity to diagnose, but management strategies depend on the patient’s clinical symptoms and fertility status. Testicular infarctions can also have challenging diagnostic and management approaches, especially when they are segmental. In all of these testicular pathologies, patient risk factors, clinical history, and physical exam are important factors to help guide diagnosis and management. In difficult cases, additional modalities including MRI can add to diagnostic certainty. Ultrasound plays a vital role in distinguishing multiple testicular abnormalities, including testicular microlithiasis, incidental non-palpable lesions, varicoceles, and testicular infarctions. This review summarizes the current literature as well as the available evidence-based guidelines to help define the strength and limitations of US. This review helps delineate the indications for follow-up ultrasound, the salient patient risk factors and clinical findings, and the role of other imaging modalities to increase diagnostic accuracy. This review will assist the radiologist in better identifying and managing these testicular abnormalities, and, in some cases, reduce the number of unnecessary radical orchiectomies.