Imaging Scrotal Lumps in Children

  • Brian D. Coley
  • Venkata R. Jayanthi
Part of the Medical Radiology book series (MEDRAD)


The discovery of a scrotal mass in a child causes great concern. While the causes of most masses are benign, the history and physical examination may not always be able to discern the etiology. Ultrasound is the most useful imaging tool to define whether or not a mass is present, and most importantly whether it is intratesticular or extrastesticular. Neoplasms are less common in the pediatric population, and are often of different histologies than in adults. Although ultrasound cannot often diagnose specific tumor types, there are a few benign lesions with sufficiently characteristic ultrasound appearances that can allow consideration for testis sparing surgery, something rarely possible in adults. Understanding the congenital and acquired masses presenting as scrotal lumps in children will improve the imager’s ability to assist our clinical colleagues with patient management.


Inguinal Hernia Germ Cell Tumor Sonographic Appearance Leydig Cell Tumor Lymphatic Malformation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agarwal P, Palmer J (2006) Testicular and paratesticular neoplasms in prepubertal males. J Urol 176:875–881PubMedGoogle Scholar
  2. Akin EA, Khati NJ, Hill MC (2004) Ultrasound of the scrotum. Ultrasound Q 20:181–200PubMedGoogle Scholar
  3. Amodio J, Maybody M, Slowotsky C et al (2004) Polyorchidism: report of 3 cases and review of the literature. J Ultrasound Med 23:951–957PubMedGoogle Scholar
  4. Aso C, Enriquez G, Fite M et al (2005) Gray-scale and color Doppler sonography of scrotal disorders in children: an update. RadioGraphics 25:1197–1214PubMedGoogle Scholar
  5. Avila NA, Premkumar A, Merke DP (1999a) Testicular adrenal rest tissue in congenital adrenal hyperplasia: comparison of MR imaging and sonographic findings. AJR 172:1003–1006PubMedGoogle Scholar
  6. Avila NA, Shawker TS, Jones JV et al (1999b) Testicular adrenal rest tissue in congenital adrenal hyperplasia: serial sonographic and clinical findings. AJR 172:1235–1238PubMedGoogle Scholar
  7. Berkmen F, Alagol H (1998) Germinal cell tumors of the testis in cryptorchids. J Exp Clin Cancer Res 17:409–412PubMedGoogle Scholar
  8. Bhatt S, Rubens DJ, Dogra VS (2006) Sonography of benign intrascrotal lesions. Ultrasound Q 22:121–136PubMedGoogle Scholar
  9. Blau H, Freud E, Mussaffi H et al (2002) Urogenital abnormalities in male children with cystic fibrosis. Arch Dis Child 87:135–138PubMedGoogle Scholar
  10. Carucci L, Tirkes A, Pretorius E et al (2003) Testicular Leydig’s cell hyperplasia: MR imaging and sonographic findings. AJR 180:501–503PubMedGoogle Scholar
  11. Ceylan H, Karaca I, Sari I et al (2004) Simple testicular cyst: a rare cuase of scrotal swelling in infancy. Int J Urol 11:352–354PubMedGoogle Scholar
  12. Chen KC, Chu CC, Chou TY et al (1998) Ultrasonography for inguinal hernias in boys. J Pediatr Surg 33:1784–1787PubMedGoogle Scholar
  13. Cho J, Chang J, Park B et al (2002) Sonographic and MR imaging findings of testicular epidermoid cysts. AJR 178:743–748PubMedGoogle Scholar
  14. Chung T, Yao W (2002) Sonographic features of polyorchidism. J Clin Ultrasound 30:106–108PubMedGoogle Scholar
  15. Chung SE, Frush DP, Fordham LA (1999) Sonographic appearances of extratesticular fluid and fluid-containing scrotal masses in infants and children: clues to diagnosis. AJR 173:741–745PubMedGoogle Scholar
  16. Ciftci A, Bingol-Kologlu M, Senocak M et al (2001) Testicular tumors in children. J Pediatr Surg 36:1796–1801PubMedGoogle Scholar
  17. Cirillo RL Jr, Coley BD, Binkovitz LA et al (1999) Sonographic findings in splenogonadal fusion. Pediatr Radiol 29:73–75PubMedGoogle Scholar
  18. Cittadini G, Gauglio C, Pretolesi F et al (2004) Bilateral epidermoid cysts of the testis: sonographic and MRI findings. J Clin Ultrasound 32:370–372PubMedGoogle Scholar
  19. Claahsen-van der Grinten HL, Sweep FCGJ, Blickman JG et al (2007) Prevalence of testicular adrenal rest tumors in male children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Eur J Endocrinol 157:339–344PubMedGoogle Scholar
  20. Coffin CM, Dehner LP (1992) The male reproductive system. In: DL Stocker JT (ed) Pediatric pathology. J.B. Lippincott Co., Philadelphia, pp 905–919Google Scholar
  21. Coley BD (2007) Sonography of pediatric scrotal swelling. Sem US, CT, MRI 28:297–306Google Scholar
  22. Coley BD, Kosnik EJ (2006) Abdominal complications of ventriculoperitoneal shunts in children. Sem US, CT, MRI 27:152–160Google Scholar
  23. Cuervo JL, Ibarra H, Molina M (2009) Abdominoscrotal hydrocele: its particular characteristics. J Pediatr Surg 44:1766–1770PubMedGoogle Scholar
  24. Danrad R, Askhker L, Smith w (2004) Polyorchidism: imaging may denote reproductive potential of accessory testicle. Pediatr Radiol 34:492–494PubMedGoogle Scholar
  25. De Backer A, Madern GC, Wolffenbuttel KP et al (2006) Testicular germ cell tumors in children: management and outcome in a series of 20 patients. J Pediatr Urol 2:197–201PubMedGoogle Scholar
  26. Deurdulian C, Mittelstaedt CA, Chong WK et al (2007) US of acute scrotal trauma: optimal technique, imaging findings, and management. RadioGraphics 27:357–369PubMedGoogle Scholar
  27. Dogra V, Gottlieb R, Rubens D et al (2001) Testicular epidermoid cysts: sonographic features with histopathologic correlation. J Clin Ultrasound 29:192–196PubMedGoogle Scholar
  28. Dogra V, Gottlieb R, Oka M et al (2003) Sonography of the scrotum. Radiology 227:18–36PubMedGoogle Scholar
  29. Dogra V, Nathan J, Bhatt S (2004) Sonographic appearance of testicular adrenal rest tissue in congenital adrenal hyperplasia. J Ultrasound Med 23:979–981PubMedGoogle Scholar
  30. Fenton L, McCabe K (2002) Giant unilateral abdominoscrotal hydrocele. Pediatr Radiol 32:882–884PubMedGoogle Scholar
  31. Frates MC, Benson CB, DiSalvo DN et al (1997) Solid extratesticular masses evaluated with sonography: pathologic correlation. Radiology 204:43–46PubMedGoogle Scholar
  32. Friedman SC, Sheynkin YR (1995) Acute scrotal symptoms due to perforated appendix in children: case report and review of literature. Pediatr Emerg Care 11:181–182PubMedGoogle Scholar
  33. Frush DP, Sheldon CA (1998) Diagnostic imaging for pediatric scrotal disorders. RadioGraphics 18:969–985PubMedGoogle Scholar
  34. Garcia CJ, Zuniga S, Rosenberg H et al (1999) Simple intratesticular cysts in children: preoperative sonographic diagnosis and histological correlation. Pediatr Radiol 29:851–855PubMedGoogle Scholar
  35. Garrett JE, Cartwright PC, Snow BW et al (2000) Cystic testicular lesions in the pediatric population. J Urol 163:928–936PubMedGoogle Scholar
  36. Gerscovich E, Kurzrock E (2002) Acoustic streaming versus venous pseudoaneurysm in a scrotal mass. J Clin Ultrasound 30:569–570PubMedGoogle Scholar
  37. Golan G, Lebensart PD, Lossos IS (1997) Ultrasound diagnosis and follow-up of testicular monocytic leukemia. J Clin Ultrasound 25:453–455PubMedGoogle Scholar
  38. Grady R (2000) Current management of prepubertal yolk sac tumor of the testis. Urol Clin North Am 27:503–508PubMedGoogle Scholar
  39. Grady RW, Ross JH, Kay R (1995) Patterns of metastatic spread in prepubertal yolk sac tumor of the testis. J Urol, 153:1259–Google Scholar
  40. Graf JL, Caty MG, Martin DJ et al (2002) Pediatric hernias. Sem US, CT, MRI 23:197–200Google Scholar
  41. Hamm B (1997) Differential diagnosis of scrotal masses by ultrasound. Eur Radiol 7:668–679PubMedGoogle Scholar
  42. Han K, Mata J, Zaontz MR (1998) Meconium masquerading as a scrotal mass. Br J Urol 82:765–767PubMedGoogle Scholar
  43. Hata S, Takahashi Y, Nakamura T et al (2004) Preoperative sonographic evaluation is a useful method of detecting contralateral patent processus vaginalis in pediatric patients with unilateral inguinal hernia. J Peds Surg 39:1396–1399Google Scholar
  44. Homayoon K, Suhre C, Steinhardt G (2004) Epididymal cysts in children: natural history. J Urol 171:1274–1276PubMedGoogle Scholar
  45. Honjo O, Uemura S, Murakami I (2001) Simple testicular cyst in infants: a case report and review of the literature. Eur J Pediatr Surg 11:425–427PubMedGoogle Scholar
  46. Hsieh DS, Jeng SY, Liu YS (1998) Bilateral idiopathic infantile pyoceles: a case report. Chung Hua I Hsueh Tsa Chih (Taipei) 61:39–43Google Scholar
  47. Ishigami K, Yousef-Zahra D, Abu-Yousef M (2004) Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia. J Clin Ultrasound 32:365–369PubMedGoogle Scholar
  48. Kao E, Gerscovich E (2003) Benign testicular lobulation: sonographic findings. J Ultrasound Med 22:299–301PubMedGoogle Scholar
  49. Karaosmanoglu D, Karcaaltincaba M, Balli O et al (2008) Sonographic findings of testicular involvement of neuroblastoma: an unusual clinical association. J Ultrasound Med 26:1785–1787Google Scholar
  50. Karmazyn B (2010) Scrotal Ultrasound. Ultrasound Clinics 5:61–74Google Scholar
  51. Kennedy PT, Elliott JM, Rice PF et al (1999) Ultrasonography of intratesticular lesions: its role in clinical management. Ulster Med J 68:54–58PubMedGoogle Scholar
  52. Kogan S, Hadziselimovic F, Howards SS et al (1996) Pediatric andrology. In: Gillenwater JY, Grayhack JT, Howards SS et al (eds) Adult and pediatric urology, Third edn edn. Mosby, St. Louis, pp 2623–2674Google Scholar
  53. Kolgesiz A, Kantarci F, Kadioglu A et al (2003) Adenomatoid tumor of the tunica vaginalis testis: a special maneuver in diagnosis by ultrasonography. J Ultrasound Med 22:303–305PubMedGoogle Scholar
  54. Korenkov M, Paul A, Troidl H (1999) Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias. J Ultrasound Med 18:565–568PubMedGoogle Scholar
  55. Koseoglu V, Akata D, Kutluk T et al (1999) Neuroblastoma with spermatic cord metastasis in a child: sonographic findings. J Clin Ultrasound 27:287–289PubMedGoogle Scholar
  56. Lim G, Lim S, Jeong Y et al (2002) Infantile scrotal pyocele simulating missed testicular torsion on sonography. J Clin Ultrasound 31:116–118Google Scholar
  57. Loberant N, Chernihovski A, Goldfeld M, et al (2002) Role of Doppler sonography in the diagnosis of cystic lymphangioma of the scrotum. J Clin Ultrasound 384–387Google Scholar
  58. Luker GD, Siegel MJ (1994a) Pediatric testicular tumors: evaluation with gray-scale and color Doppler US. Radiology 191:561–564PubMedGoogle Scholar
  59. Luker GD, Siegel MJ (1994b) Color Doppler sonography of the scrotum in children. AJR 163:649–655PubMedGoogle Scholar
  60. Maizlin ZV, Belenky A, Kunichezky M et al (2004) Leydig cell tumor of the testis: gray scale and color Doppler sonographic appearance. J Ultrasound Med 23:959–964PubMedGoogle Scholar
  61. Maizlin Z, Belenky A, Baniel J et al (2005) Epidermoid cyst and teratoma of the testis: sonographic and histologic similarities. J Ultrasound Med 24:1403–1409PubMedGoogle Scholar
  62. Malik MA, Iqbal Z, Chaudri KM et al (2008) Crossed testicular ectopia. Urology 71:984.e985–e986Google Scholar
  63. Manning MA, Woodward PJ (2010) Testicular epidermoid cysts: sonographic features with clinicopathologic correlation. J Ultrasound Med 29:831–837PubMedGoogle Scholar
  64. Marjanovic ZO, Perovic SV, Slavkovic A et al (2007) Transverse testicular ectopia with and without persistent Mullerian duct syndrome. Int Urol Nephrol 39:1167–1171PubMedGoogle Scholar
  65. Mazzu D, Jeffrey RB, Ralls PW (1995) Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR 164:645–647PubMedGoogle Scholar
  66. Merlini E, Seymandi PL, Betta PG et al (2003) Testis sparing enucleation of a Leydig-cell tumour in a boy. Pediatr Med Chir 25:63–65PubMedGoogle Scholar
  67. Metcalfe P, Farivar-Mohseni H, Farhat W et al (2003) Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery. J Urol 170:2412–2416PubMedGoogle Scholar
  68. Moghe PK, Brady AP (1999) Ultrasound of testicular epidermoid cysts. Br J Radiol 72:942–945PubMedGoogle Scholar
  69. Moore W, Li S, Rifkin MD (2003) Juvenile granulosal cell tumor of the testicle. Ultrasound Quarterly 19:39–41PubMedGoogle Scholar
  70. Netto J, Perez L, Kelly D et al (2004) Splenogonadal fusion diagnosed by Doppler ultrasonography. Scientific World Journal 4(Suppl 1):253–257PubMedGoogle Scholar
  71. Neumann DP, Abrams GS, Hight DW (1997) Testicular epidermoid cysts in prepubertal children: case report and review of the world literature. J Pediatr Surg 32:1786–1789PubMedGoogle Scholar
  72. Papaioannou G, Sebire NJ, McHugh K (2009) Imaging of the unusual pediatric ‘blastomas’. Cancer Imaging 9:1–11PubMedGoogle Scholar
  73. Patel AS, Coley BD, Jayanthi VR (2007) Ultrasonography underestimates the volume of normal parenchyma in benign testicular masses. J Urol 178(4 Pt 2):1730–1732PubMedGoogle Scholar
  74. Patriquin HB (1993) Leukemic infiltration of the testis. In: PA Siegel BA (ed) Pediatric Disease (Fourth series) test and syllabus. American College of Radiology, Reston, VA, pp 667–688Google Scholar
  75. Pohl H, Shukla A, Metcalf P et al (2004) Prepubertal testis tumors: actual prevalence rate of histological types. J Urol 172:2370–2372PubMedGoogle Scholar
  76. Ricci Z, Stein M, Koenigsberg M et al (2004) Unusual sonographic appearance of a Leydig cell tumor of the testis. Pediatr Radiol 34:177–178PubMedGoogle Scholar
  77. Robinson P, Hensor E, Lansdown M et al (2006) Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features. AJR 187:1168–1178PubMedGoogle Scholar
  78. Ross J, Rybicki L, Kay R (2002) Clinical behavior and contemporary management algorithm for prepubertal testis tumors: a summary of the prepubertal testis tumor registry. J Urol 168:1675–1679PubMedGoogle Scholar
  79. Rousso I, Iliopoulos D, Athanasiadou F et al (2006) Congenital bilateral anorchia: hormonal, molecular and imaging study of a case. Genet Mol Res, 5:638–642PubMedGoogle Scholar
  80. Rubenstein R, Dogra V, Seftel A et al (2004) Benign intrascrotal lesions. J Urol 141:1765–1772Google Scholar
  81. Shah S, Miller B, Geisler E (1992) Polyorchidism discovered as testicular torsion. Urology 39:543–544PubMedGoogle Scholar
  82. Shin SL, Outwater EK (2007) Benign large cell calcifying Sertoli cell tumor of the testis in a prepubescent patient. AJR 189:W65–W66PubMedGoogle Scholar
  83. Shukla A, Woodard C, Carr M et al (2004a) Experience with testis sparing surgery for testicular teratoma. J Urol 171:161–163PubMedGoogle Scholar
  84. Shukla A, Huff D, Canning D et al (2004b) Juvenile granulosa cell tumor of the testis: contemporary clinical management and pathological diagnosis. J Urol 171:1900–1902PubMedGoogle Scholar
  85. Sista AK, FILLY RA (2008) Color Doppler sonography in evaluation of spermatoceles: the “falling snow” sign. J Ultrasound Med 27:141–143PubMedGoogle Scholar
  86. Skoog SJ (1997) Benign and malignant pediatric scrotal masses. Pediatr Clin North Am 44:1229–1250PubMedGoogle Scholar
  87. Srinivasan AS, Darge K (2009) Neonatal scrotal abscess: a differential diagnostic challenge for the acute scrotum. Pediatr Radiol 39:91PubMedGoogle Scholar
  88. Stewart V, Sellars M, Somers S et al (2004) Splenogonadal fusion: B-mode and color Doppler sonographic appearances. J Ultrasound Med 23:1087–1090PubMedGoogle Scholar
  89. Stikkelbroeck NM, Suliman HM, Otten BJ et al (2003) Testicular adrenal rests in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features. Eur Radiol 13:1597–1603PubMedGoogle Scholar
  90. Stroosma OB, Delaere KP (2008) Carcinoid tumours of the testis. BJU Int 101:1101–1105PubMedGoogle Scholar
  91. Sudakoff G, Quiroz F, Karcaaltincaba M et al (2002) Scrotal ultrasonography with emphasis on the extratesticular space: anatomy, embryology, and pathology. Ultrasound Quarterly 18:255–273PubMedGoogle Scholar
  92. Sung T, Riedlinger W, Diamond D et al (2006) Solid extratesticular masses in children: radiographic and pathologic correlation. AJR 186:483–490PubMedGoogle Scholar
  93. Thomas J, Ross J, Kay R (2001) Stromal testis tumors in children: a report from the prepubertal testis tumor registry. J Urol 166:2338–2340PubMedGoogle Scholar
  94. Trobs RB, Friedrich T, Lotz I et al (2002) Wilms’ tumour metastasis to the testis: long-term survival. Pediatr Surg Int 18:541–542PubMedGoogle Scholar
  95. Turgut AT, Olcucuoglu E, Turan C et al (2007) Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. J Ultrasound Med 26:1657–1666PubMedGoogle Scholar
  96. Upadhyay V, Holmes M, Kolbe A (1998) Gonadal preservation in a simple testicular cyst. Pediatr Surg Int 13:445–446PubMedGoogle Scholar
  97. Varkonyi I, Fliegel C, Rosslein R et al (2000) Meconium periorchitis: case report and literature review. Eur J Pediatr Surg 10:404–407PubMedGoogle Scholar
  98. Varma DR, Sirineni GR, Rao MV et al (2007) Sonographic and CT features of splenogonadal fusion. Pediatr Radiol 37:916–919PubMedGoogle Scholar
  99. Walker RN, Murphy TJ, Wilkerson ML (2008) Testicular hamartomas in a patient with Bannayan-Riley-Ruvalcaba syndrome. J Ultrasound Med 27:1245–1248PubMedGoogle Scholar
  100. Weidman E, Cendron M, Schned A et al (2002) Scrotal lymphangioma: an uncommon cause for a scrotal mass. J Ultrasound Med 21:669–672PubMedGoogle Scholar
  101. Williams H, Abernethy L, Losty P et al (2004) Meconium periorchitis: a rare cause of a paratesticular mass. Pediatr Radiol 34:421–423PubMedGoogle Scholar
  102. Woodard P, Sohaey R, O’Donoghue M et al (2002) Tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. RadioGraphics 22:189–216Google Scholar
  103. Wu H, Snyder H (2004) Pediatric urologic oncology: bladder, prostate, testis. Urol Clin North Am 31:619–627PubMedGoogle Scholar
  104. Yasumoto R, Kawano M, Kawanishi H et al (1998) Left acute scrotum associated with appendicitis. Int J Urol 5:108–110PubMedGoogle Scholar
  105. Yikilmaz A, Lee EY (2007) MRI findings of bilateral juvenile granulosa cell tumors of the testis in a newborn presenting as intraabdominal masses. Pediatr Radiol 37:1031–1034PubMedGoogle Scholar
  106. Zeger MP, Zinn AR, Lahlou N et al (2008) Effect of ascertainment and genetic features on the phenotype of Klinefelter syndrome. J Pediatr 152:716–722PubMedGoogle Scholar
  107. Zuppa AA, Nanni L, Di Gregorio F et al (2006) Complete epididymal separation presenting as polyorchidism. J Clin Ultrasound 34:258–260PubMedGoogle Scholar
  108. Zwanger-Mendelson S, Schneck EH, Doshi V (1989) Burkitt lymphoma involving the epididymis and spermatic cord: sonographic and CT findings. AJR 153:85–86Google Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of RadiologyNationwide Children’s HospitalColumbusUSA
  2. 2.Department of Pediatric UrologyNationwide Children’s HospitalColumbusUSA

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