Testicular Atrophy Reporting on Ultrasound
No, a sonographer will not always report testicular atrophy on ultrasound—it depends on whether the atrophy is clinically significant, whether it meets diagnostic thresholds, and the sonographer's recognition of the finding.
What Constitutes Reportable Testicular Atrophy
- Testicular atrophy is defined as testicular volume less than 12 ml, which is the established threshold used in clinical practice 1, 2.
- Volume reduction greater than 50% compared to the contralateral testis is another criterion used to diagnose atrophy, particularly in post-torsion cases 3.
- Sonographers measure testicular dimensions (length, width, height) and calculate volume using the formula π/6 × length × height × width 2.
Why Atrophy May Not Always Be Reported
Technical and Clinical Factors
- Mild atrophy may not be recognized if the sonographer doesn't systematically measure and calculate testicular volume in every case 1.
- Bilateral symmetric atrophy can be missed because there's no normal contralateral testis for comparison 3.
- Scrotal ultrasound for volume assessment is not routinely performed unless there are specific indications such as large hydrocele, inguinal testis, or small testis where the epididymis appears disproportionately large 1.
- In clinical practice, Prader orchidometer measurement is often used instead of ultrasound for routine volume assessment, as it's easier and more cost-effective 1.
Sonographic Appearance of Atrophy
- Heterogeneous or mottled testicular echotexture is the primary sonographic finding associated with atrophy, representing seminiferous tubule sclerosis 4.
- The prevalence of heterogeneous testes in elderly populations is approximately 14%, and all cases correspond to extensive tubular atrophy 4.
- Atrophy may appear as homogeneous but reduced in volume, or as heterogeneous with reduced vascularity on color Doppler 5, 6.
Clinical Contexts Where Atrophy Should Be Reported
High-Risk Scenarios
- Testicular atrophy is a risk factor for testicular cancer and should always be documented when present 7.
- Post-torsion salvage cases: 54% of patients develop atrophy after testicular salvage surgery, typically within 14 months 3.
- Cryptorchidism: Atrophy in the setting of undescended testis warrants contralateral testicular biopsy consideration 1.
- Infertility evaluation: Atrophy assessment is critical, as men with oligozoospermia have an 11.9-fold higher cancer risk 1.
Specific Ultrasound Indications for Atrophy Assessment
- Detection of testicular dysgenesis signs including non-homogeneous architecture and microcalcifications 1.
- Evaluation after scrotal trauma: 50% of patients develop atrophy following blunt scrotal trauma 6.
- Assessment of intratesticular varicocele: Rarely associated with atrophy and parenchymal abnormalities 5.
Common Pitfalls
- Assuming normal appearance excludes atrophy: Older patients with heterogeneous testes and normal color Doppler flow likely have benign tubular atrophy and don't need follow-up, but the finding should still be documented 4.
- Failing to measure both testes: Comparison with the contralateral side is essential for detecting unilateral atrophy 3.
- Not recognizing severe atrophy (≤8 ml): This is more commonly associated with testicular microlithiasis and represents a higher-risk finding 2.
- Overlooking heterogeneous echogenicity: This finding predicts testicular atrophy in post-torsion cases (p=0.001) and should trigger careful volume assessment 3.
Practical Approach
When atrophy should be actively sought and reported:
- Any patient with risk factors for testicular cancer (cryptorchidism, family history, prior cancer) 7
- Post-torsion follow-up (all patients should be counseled about 54% atrophy risk) 3
- Infertility workup 1
- Scrotal trauma follow-up 6
- When heterogeneous echotexture is identified 4
The sonographer's role is to document objective measurements and describe echogenicity patterns, but whether atrophy is explicitly stated in the report depends on the radiologist's interpretation and the clinical context 1.