Ultrasound of the pediatric scrotum

Clinical evaluation of pediatric scrotal pathologies can be challenging. Different pathologies have similar presentations, and scrotal tenderness may limit physical examination. Ultrasound (US) is the imaging modality of choice for the pediatric scrotum. It provides excellent anatomical detail and assessment of testicular perfusion by color Doppler without ionizing radiation. Scrotal US examination should also include the inguinal area; inguinal canal pathology can extend into the scrotum. In the pediatric acute scrotum, US can differentiate between testicular torsion requiring scrotal exploration and other pathologies with conservative management. This article will review scrotal US anatomy and demonstrate how US can guide management in a variety of scrotal abnormalities including trauma, masses, varicocele, and cryptochydism.