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Questions on testicular ultrasound

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I have questions regarding my testicular ultrasound results. I was not given any clear interpretation of the results, but just a recommended follow-up with a urologist. I am seeing a local urologist next week but I would like some insight on the ultrasound results that I have received so that I know what to ask during my appointment.

My ultrasound was ordered by my general doctor because I have been having pain in my right testicle over the last month and nothing came up as an infection in my urine analysis. It was expected to be epididymitis and orchitis. My right testicle has been somewhat sensitive in the past, but it has never caused me pain like it has recently. It has also always been smaller than the left, but I'm concerned it may have atrophied without me noticing.

My main questions are as follows:

1. It was indicated that NO MASS was found. Does this mean I'm clear from cancer? If cancer was suspected I would think that I would be directed for immediate surgery for removal.

2. Right testicle is about 1/3 the volume of the left. It has not changed in size recently. Of what concern is this?

3. Ultrasound indicates no intratesticular mass but does indicate "scattered punctate echogenic reflectors which probably represent dystrophic calcifications." Would these be located outside of the testicle?

4. Ultrasound suggest atrophy and infarction. Is this of major concern? It also say blood flow is normal and that no masses were found. Why wouldn't these items show up as masses or irregular blood flow the ultrasound?


Below is my complete ultrasound results with impressions from the hospital radiology department:


PROCEDURE: Ultrasound of Scrotum/Testes

HISTORY: 36 year old male with right testicular pain.

TECHNIQUE: Ultrasound of the scrotum was performed.

COMPARISON: None available.

FINDINGS:

MEASUREMENTS:
Right testis: 3.3 x 1.2 x 2.3 cm (Length x AP x Width)
Left testis: 4.7 x 1.9 x 3.4 cm (Length x AP x Width)

TESTES: The right testis is markedly decreased in size and is abnormally
hypoechoic with scattered punctate echogenic reflectors which probably represent
dystrophic calcifications. The left testes is normal in size and echogenicity.
No intratesticular mass is seen. Symmetric arterial flow is present in both
testes on color flow and spectral Doppler evaluation.

EPIDIDYMIDES: The epididymides are not enlarged.

OTHER: There is no hydrocele or varicocele. There is a 0.3 cm scrotolith on the
right.

IMPRESSION:

Small, hypoechoic right testis contains some dystrophic calcifications. This is
probably due to a prior right testicular infarction from either infection or
vascular insult. There is no right testicular mass. Clinical follow-up is
recommended.

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
 32 Doctors Online

Dear Sir,

I have reviewed your ultrasound report. You don't have cancer and calcifications within the testis are microliths and they have no significance; they are essentially normal.

Your right testis is certainly smaller than the other side and is probably due to some insult earlier in life. (some vascular injury / torsion of testes) It should not impair your sexaul or fertility potential in way under normal circumstances. There is no indication of any tumor or mass.

Stop worrying; your ultrasound looks good.
Hope this helps
Please feel free to ask followup questions.

Sincerely

Rajiv goel

Dr Rajiv Goel
MS (AIIMS), MCh (AIIMS), DNB ( Uro)
Fellow, Urooncology and Robotic urology, Australia
Fellow, Laparoscopic urology, Germany


Patient replied :

Thank you Dr. Goel

One more thing I would like to know:

If the microliths are numerous and considered microlithiasis I have read this is sometimes associated with an increased risk of cancer. I have read that atrophy is also an increased risk.

Should consideration be taken for a aggressive future sceenings given both of these conditions? Such as yearly ultrasounds and blood test for tumor markers?

Thank you


Hello again,

Yes both atrophy and microliths have been associated with cancer. However, whether it is truly increased incidence or just a coincidence we are not very sure.

However, you should be proactive in ruling out development of malignany and the best way is to self examine every day while taking bath. Testis with testicular cancer shall become hard and also lose the sensation of pain when pressed.

Sincerely


Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
DNB - NBE
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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