page_title: Scrotal ultrasound
section_title: Anatomy
hierarchical_section_title: Scrotal ultrasound / Anatomy
caption_attribution_description: English: Scrotal ultrasonography with Doppler of an 85 year old man with hydrocele, making the appendix of the testicle clearly distinctive as a 4 mm outpouching.
context_page_description: Scrotal ultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.
context_section_description: The normal adult testis is an ovoid structure measuring 3 cm in anterior-posterior
  dimension, 2–4 cm in width, and 3–5 cm in length. The weight of each testis normally ranges
  from 12.5 to 19 g. Both the sizes and weights of the testes normally decrease with age. At
  ultrasound, the normal testis has a homogeneous, medium-level, granular echotexture. The
  testicle is surrounded by a dense white fibrous capsule, the tunica albuginea, which is often
  not visualized in the absence of intrascrotal fluid. However, the tunica is often seen as an
  echogenic structure where it invaginates into the testis to form the mediastinum testis. In the testis, the seminiferous tubules converge to form the rete testes, which is
  located in the mediastinum testis. The rete testis connects to the epididymal head via the
  efferent ductules. The epididymis is located posterolateral to the testis and measures 6–7 cm
  in length. At sonography, the epididymis is normally iso- or slightly hyperechoic to the
  normal testis and its echo texture may be coarser. The head is the largest and most easily
  identified portion of the epididymis. It is located superior-lateral to the upper pole of the
  testicle and is often seen on paramedian views of the testis. The normal epididymal
  body and tail are smaller and more variable in position.
  The testis obtains its blood supply from the deferential, cremasteric and testicular arteries.
  The right and left testicular arteries, branches of the abdominal aorta, arise just distal to the
  renal arteries, provide the primary vascular supply to the testes. They course through the
  inguinal canal with the spermatic cord to the posterior superior aspect of the testis. Upon
  reaching the testis, the testicular artery divides into branches, which penetrate the tunica
  albuginea and arborize over the surface of the testis in a layer known as tunica vasculosa.
  Centripetal branches arising from the capsular arteries carry blood toward the mediastinum,
  where they divide to form the recurrent rami that carry blood away from the mediastinum
  into the testis. The deferential artery, a branch of the superior vesicle artery and the
  cremasteric artery, a branch of the inferior epigastric artery, supply the epididymis, vas
  deferens, and peritesticular tissue.
  Four testicular appendages have been described: the appendix testis, the appendix
  epididymis, the vas aberrans, and the paradidymis. They are all remnants of embryonic
  ducts. Among them, the appendix testis and the appendix epididymis are usually seen at scrotal US. The appendix testis is a
  Müllerian duct remnant and consists of fibrous tissue and blood vessels within an envelope
  of columnar epithelium. The appendix testis is attached to the upper pole of the testis and
  found in the groove between the testis and the epididymis. The appendix epididymis is
  attached to the head of the epididymis. The spermatic cord, which begins at the deep
  inguinal ring and descends vertically into the scrotum consists of vas deferens, testicular
  artery, cremasteric artery, deferential artery, pampiniform plexuses, genitofemoral nerve,
  and lymphatic vessel.
caption: Scrotal ultrasonography with Doppler of an 85-year-old man with hydrocele, making the appendix of the testicle clearly distinctive as a 4 mm outpouching.
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