Will a Sonographer Report Testicular Atrophy on Ultrasound?
Yes, a sonographer should document testicular atrophy when present, as it is a critical finding with significant clinical implications including increased cancer risk and fertility concerns. 1
What Sonographers Measure and Document
Sonographers routinely measure testicular dimensions (length, height, width) and calculate volume using the formula π/6 × length × height × width, though this is not always performed in every examination. 1
Testicular atrophy is defined as testicular volume less than 12 mL, which is the established clinical threshold. 1
The sonographer's primary role is to document objective measurements and describe echogenicity patterns, but whether atrophy is explicitly stated in the final report depends on the radiologist's interpretation and the clinical context. 1
When Atrophy Must Be Reported
Testicular atrophy should always be documented when present because it represents a significant risk factor for testicular cancer and is critical in infertility evaluation. 1
High-Priority Clinical Contexts:
Cancer risk assessment: Men with testicular atrophy have an 11.9-fold higher cancer risk, particularly in the setting of cryptorchidism, family history, or prior cancer. 1
Infertility workup: Atrophy is a critical factor in evaluating male fertility, especially in men with oligozoospermia or azoospermia. 2, 1
Undescended testis: Marked atrophy in the setting of cryptorchid testis warrants consideration of contralateral testicular biopsy. 2, 1
Ultrasound Findings of Testicular Atrophy
Atrophic testes demonstrate characteristic sonographic features that sonographers should recognize and document:
Reduced testicular volume compared to the contralateral testis (typically >50% difference indicates significant atrophy). 3
Altered echogenicity patterns: Atrophic testes may appear heterogeneously hypoechoic with multiple hyperechoic islands, or heterogeneously hyperechoic. 4
Shape changes: Atrophic testes often exhibit an oblong rather than normal elliptical shape. 4
Decreased vascularity on color Doppler examination compared to the contralateral testis. 4
Common Causes of Testicular Atrophy
Understanding the etiology helps sonographers recognize when atrophy documentation is particularly important:
Post-torsion: Approximately 54% of patients who undergo testicular salvage after torsion develop atrophy, typically evident by 12.5 months post-operatively. 3
Post-infectious: Mumps orchitis can lead to atrophy, with affected testes showing 23-55% volume reduction (mean 44.7%) compared to normal contralateral testes. 4
Trauma: Scrotal trauma causes testicular atrophy in approximately 50% of cases, with affected testes showing reduced volume and sometimes heterogeneous echogenicity with reduced flow. 5
Cryptorchidism: Undescended testes frequently develop atrophy and require careful documentation. 2, 1
Critical Pitfalls to Avoid
Do not assume asymmetry is normal variation without measuring and documenting actual volumes, as significant pathology may be masked. 1, 6
Always use the contralateral testis as an internal control to assess for true pathologic asymmetry. 6
Perform Doppler evaluation even when grayscale appearance seems normal, as perfusion abnormalities may indicate underlying pathology. 6
Document suspicious findings such as hypoechoic masses or macrocalcifications that may be associated with atrophy, as these require further evaluation with tumor markers. 2, 1
Practical Approach for Sonographers
The sonographer should actively measure and document testicular volumes bilaterally, calculate the percentage difference, and describe any associated findings such as:
- Altered echogenicity patterns 4
- Shape abnormalities 4
- Doppler flow characteristics 4
- Presence of masses, calcifications, or other structural abnormalities 2, 1
The radiologist will then interpret these objective findings and determine whether to explicitly state "testicular atrophy" in the final report based on the clinical context and indication for the examination. 1