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A Man’s Guide to Testicular Ultrasound

Article by: Todd Roth, MD

Testicular ultrasound is a non-invasive, painless way for specialists to evaluate out-of-the-ordinary symptoms that a man may be experiencing in his testicles. The most common symptoms that lead to a testicular ultrasound include pain, swelling or the detection of a lump. Occasionally, ultrasound is also needed to examine an injury to the testicular area. Typically, a man is referred to a radiologist for a testicular ultrasound by his primary care physician or urologist.

“Some men will experience new pain and/or swelling in their testicle(s) for several days, waiting until things progress before they visit their doctor,” explained Dr. Todd Roth, nuclear medicine and abdominal imaging radiologist at Raleigh Radiology. “However, I would encourage any man not to wait. In most cases the symptoms he is experiencing will be due to an easily treatable infection or other minor condition; however, the symptoms could be due to a more serious condition such as twisting of the blood vessels (testicular torsion) which, if not treated quickly, could lead to loss of the testicle. If a man notices a new lump without pain it is likely not urgent, but he should still schedule an appointment with his doctor and get it evaluated. “

Details of the Testicular Ultrasound Exam

When a man arrives to the radiologist’s office for a testicular ultrasound, he will be asked to change into a hospital-type gown and lie flat on the exam table. He will then meet the ultrasonographer who is specially trained to perform this type of exam.

With an ultrasound probe (or transducer), the ultrasonographer will scan the area of concern – the testicles and surrounding structures. Ultrasound does not use radiation, but instead uses sound waves and a computer to create still pictures and movies of the interiors of these areas.

Occasionally, the ultrasonographer may ask the radiologist to look at the images while the patient is in the room, but in most cases they will send the images to the radiologist for later interpretation. In total, the testicular ultrasound scan should only take around 15 to 30 minutes. Results will be sent to the referring provider within a few days.

What Do the Ultrasound Images Show?

When reviewing testicular ultrasound scans, the radiologist analyzes many different types of anatomy, including the testicles, the epididymis (tube along the back of each testicle that carries and stores sperm cells), soft tissues in the testicular and surrounding area, as well as the blood vessels that supply blood to the testicles. In particular, he or she will pay close attention to the:

  • Symmetry and size of the testicles
  • Swelling or enlargement of the testicles
  • Density of the testicle (echogenicity)
  • loss or decrease of blood flow

Conditions Diagnosed by Testicular Ultrasound

The most urgent problem the radiologist is looking for is the loss or decrease of blood flow to the testicle, which occurs when the blood vessels become twisted. Although relatively rare, this dangerous condition is called testicular torsion and is of urgent concern. It requires immediate evaluation by a urologist and surgery to untwist the blood vessels. Other, less-concerning conditions that are diagnosed by testicular ultrasound include:

  • Orchitis – Swelling/inflammation of the testicle due to a bacterial or viral infection
  • Epididymitis – Swelling/inflammation of the epididymitis due to bacterial or viral infection
  • Varicocele – Enlargement of the veins within the scrotum (loose sac of skin that holds each testicle)
  • Hydrocele – A collection of fluid around the testicle
  • Spermatocele – A round fluid-filled cyst that develops in the epididymis

Inflammation of the epididymis or testicle is most commonly caused by spread of infection from the bladder or prostate. It is usually treated with antibiotics and medication for pain control. A varicocele is most commonly due to a congenital abnormality in the veins or may rarely be due to vein compression or obstruction. It typically does not cause symptoms or require treatment but in some cases may cause swelling/pain or lead to infertility, in which case surgical treatment may be needed. A hydrocele is the most common cause of swelling and may be congenital but is usually due to another underlying condition such as inflammation or injury. They will typically resolve on their own and only rarely require minor surgery. The detection of a spermatocele – even though it is not harmful – will typically result in referral to a urologist to decide if the “watch and wait” method will be used or if minor surgery is needed.

The Rare Case of Testicular Cancer

On a rare occasion, a malignant lump is detected inside the testicle, and the diagnosis is testicular cancer. The ultrasound images will show a nodule or mass in the testicle that shows the typical features of cancer. If the radiologist suspects a primary testicular cancer, the patient will be referred to a urologist for treatment.

Raleigh Radiology Cares

“At Raleigh Radiology, we are committed to using the latest technology and ultrasound equipment as well as the highest standard of care when performing and reviewing testicular ultrasounds,” added Dr. Roth. “While the more serious conditions such as torsion and testicular cancer are generally rare, it is important for men who are experiencing any symptoms to get checked out as soon as possible. This will help eliminate concern and avoid delaying any necessary treatment.”

For more information about testicular ultrasound at Raleigh Radiology, please visit


About the Author

Todd Roth, MD is a Body Imaging, Nuclear Medicine Radiologist at Raleigh Radiology.
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