A pictorial of rare artefacts in scrotal ultrasonography

Although easily performed and with optimal clinical results, scrotal ultrasound examinations are not free from technical difficulties. Some artifacts are relatively frequent, their creation mechanisms are well known and are easily recognized; others are uncommon, produce images which can be difficult to recognize, and need modifications of scan planes and examination techniques to be properly understood. The aim of this paper is to describe some rare artifacts and pitfalls in scrotal ultrasound, trying to explain their genesis and how to avoid them. We describe four different artifacts (flow signals not related to blood flow, refraction phenomena causing appearance of testicular pseudo-masses, pseudo-thickening of the tunica vaginalis, testicular anomalous echogenicity from thickening of the scrotal wall) that can cause diagnostic difficulties during scrotal examinations.