Bilateral spermatocele with tubular ectasia of the rete testes
Presentation
Evaluation for azoospermia with bilateral scrotal palpable masses.
Patient Data
Both testes show multiple cystic & tubular anechoic structures seen at testicular mediastinum (rete testis) giving diffusely speckled appearance more marked on right.
Non-visualized both epididymal heads replaced by multi-locular cystic lesions about 4.5x2.6 cm and 5.1x2.8 cm are seen cranial to right and left testis respectively with fine basal internal echoes & pushing testes slightly downwards.
Left mild and right minimal hydrocele is incidentally noted.
Differential diagnosis:
- epididymal cyst
- ectasia of rete testes
- intratesticular simple cyst
- encysted hydrocele:
For a complete discussion of the radiological features and differentials please see spermatocele.
Case Discussion
Findings are highly suggestive of bilateral large spermatocele formations with significant tubular ectasia of the rete testis.
Spermatoceles are seen as unilocular or rarely multilocular extra-testicular cysts caused by cystic dilatation of tubules of the efferent ductules in the head of the epididymis.
On ultrasound studies, they appear as well-defined epididymal cystic lesions, with low-level fine internal echoes, and posterior acoustic enhancement. Thin septations may be present.
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