1975, British Journal of Radiology, 48, 179-180

MARCH

1975

Preliminary communication Soft tissue radiography of the testicles By J. L Price, M.B., F.F.R., D.M.R.D., and B. J. Loveday, M.B., M.R.C.S., LR.C.P., F.F.R., D.M.R.D. Royal Surrey County Hospital, Guildford and Cambridge Military Hospital, Aldershot {Received May, 1974)

Radiology has played little part in the diagnosis of scrotal swellings in the past. A technique has been developed from that used in mammography to aid the diagnosis of difficult cases. A single Medichrome film is backed by a fine-grain, high-definition screen and these are vacuum packed in a thin opaque polythene envelope. A Machlett, HD 50 Mo tube is used. The exposure factors used are 30 kVp, 12-15 mAs at 70 cm FFD. The skin radiation dose measured by an EIL 37C dose meter and lithium borate sachets is less than 0-3 rad per exposure. The patient is usually positioned in a semi-reclining position with the scrotum resting on the film in its vacuum pack. The X-ray tube is angled 15 deg towards the feet. Usually one antero-posterior view is adequate but a certain degree of ingenuity may be required to overcome variations in build and physique, and oblique views are sometimes taken. Twenty-three patients have now been examined radiologically. There were seven neoplasms and 16 cases of benign conditions. In all these patients the diagnosis was confirmed at operation and on subsequent histological examination.

Some results are presented in Figs. 1, 2 and 3. RADIOLOGICAL APPEARANCES

The radiological appearances of the normal scrotum have been obtained by studying the unaffected side. The healthy side of the scrotum acts as a convenient and accurate control, for it is subject to the same radiographic variables as the affected side. The normal testicle is oval in shape and approximately 4-5 cm long. It is of medium radiographic density and has a sharply defined proximal border, which is clearly separate from the wall of the scrotum

FIG. 3. Right Varicocoele.

FIG.1.

Right seminoma. 179

VOL.

48, No. 567 jf. L. Price and B. J. Loveday

and from the median septum. The epididymis and spermatic cord can be seen arising from the upper pole of the testicle. Malignant testicular tumours, six seminomas and one teratoma in the series, appear as a very radioopaque generalized enlargement of the testicle. The margin of the testicle appears to be sharply defined, particularly on the medial side adjacent to the septum. Benign conditions, epididymal cysts, hydrocoelesand inflammation of the tunica vaginalis appear as a generalized increase in size and radio-opacity of the scrotum compared with the unaffected side. But they appear less radio-opaque than testicular tumours and the margins of the testicle are less

180

clearly defined. At operation this has been found to be due to low grade inflammation. Varicocoeles have quite a characteristic appearance and the radiological features correlate very closely with the classical "bag of worms" description. Although the series is small, the radiological features are being established with some degree of consistency. The clinicians who have referred the cases feel that soft tissue radiography of the testicles forms a useful extension of the clinical examination and when allied with the full clinical picture is a useful aid to diagnosis. We feel that early results justify continued development and assessment of the technique.

Soft tissue radiography of the testicles.

1975, British Journal of Radiology, 48, 179-180 MARCH 1975 Preliminary communication Soft tissue radiography of the testicles By J. L Price, M.B.,...
226KB Sizes 0 Downloads 0 Views