Scrotal sonography in infants and children

In this review we will attempt to summarize the use of scrotal sonography in infants and children. The material is gathered from the literature and from our own experience of 197 sonograms performed on 175 pediatric patients. Included will be information on testicular development and descent, normal sonographic anatomy, classification of scrotal disease, and the final diagnoses of the sonograms. Scrotal sonography has proven useful in evaluating undescended testes in the inguinal canal and just inside the inguinal ring. It is of limited value when the testes are in the abdomen. Sonography can often distinguish the various causes of nonpainful scrotal masses such as tumors, hydrocele, and meconium peritonitis. Sonography is highly accurate in distinguishing normal from abnormal scrotal contents and in separating testicular from extratesticular masses. However, sonography does have limitations in distinguishing benign from malignant neoplasms or from some inflammatory lesions. Sonography can be successfully used in the differential diagnosis of the painful scrotum especially with color flow Doppler. Inflammatory diseases that often involve the epididymis can be distinguished from torsion. Torsion of the appendages has been diagnosed. In cases of scrotal trauma, management decisions are often based on the sonographic findings. Conditions that require surgical management such as testicular rupture or large testicular hematomas can be recognized. Information is included on a variety of miscellaneous conditions such as hydrocele, varicocele, and ambiguous genitalia in which sonography has proven valuable.