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1351.

Imaging 2005;17:171-207.
Imaging of back pain
J Teh, A Imam, and C Watts
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Figure 21. (a) Giant cell tumour of the sacrum. Axial CT demonstrates an expansile lytic lesion that crosses the sacroiliac joint to involve the ilium. The arrows point to a thin cortical rim that illustrates the expansile nature of the lesion. (b) Giant cell tumour of the sacrum. Sagittal T₂ weighted image demonstrating an eccentric mass lesion with secondary aneurysmal bone cyst formation (arrow).

1352.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 1. Mediastinum testis. Linear high reflective band traversing the testis in a craniocaudal direction (arrow).

1353.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 10. Ectasia of the rete testis. Multiple fluid filled structures in the expected position of the mediastinum testis (arrow).

1354.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 11. Carcinoma of the rete testis. There is a heterogeneous, well-defined intratesticular lesion (arrow). Orchidectomy confirmed the diagnosis.

1355.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 12. (a) Epidermoid tumour. Focal heterogeneous intratesticular lesion with peripheral calcification (arrow). (b) Epidermoid tumour. Note the "onion skinning", a classical appearance (arrow).

1356.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 13. Focal infarction. Well-defined, low reflective intratesticular lesion with no Doppler flow signal (arrow).

1357.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 14. Focal orchitis. (a) A 55-year-old man presented with a 5 day history of testicular pain and swelling. Ultrasound demonstrates a loculated hydrocele and a focal low reflective lesion in the upper pole of the testis with no increase in the colour Doppler signal; appearances are consistent with orchitis (arrow). Follow up ultrasound is always advised in such patients to confirm resolution of the changes and to monitor the appearance of the testicular lesion. (b) The same patient imaged 3 months later demonstrating persistence of the hypervascular ill defined intratesticular lesion (arrow). Orchidectomy was performed as there was concern that there may be a tumour in the testis.

1358.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 15. Testicular sarcoid. (a) There is an ill defined low reflective intratesticular lesion within the centre of the testis in a patient with no past history of sarcoid (arrow). (b) In the same patient, smaller low reflective lesions are present in the contralateral testis (arrows). Testicular biopsy was performed to confirm the diagnosis of sarcoid. The chest radiograph demonstrated bilateral hilar lymph node enlargement.

1359.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 16. Adrenal rests. There is a well-defined, low reflective lesion in the central aspect of the testis (arrow).

1360.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 17. Polyorchidism. Two isoreflective testes are noted within the same hemi-scrotum, separated by low reflective tissue (arrow).

1361.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 18. Epididymal cyst. There is a well-defined anechoic lesion in the head of the epididymis associated with a hydrocele (arrow). Note the absence of internal echoes within the lesion.

1362.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 19. Acute epididymitis. Enlarged, high reflective, hypervascular epididymal lesion (arrow). The adjacent testis is normal.

1363.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 2. Appendix testis. Isoreflective nodule noted adjacent to the upper pole of the testis associated with a hydrocele (arrow).

1364.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 20. Varicocele. A simple left sided varicocele. Multiple serpiginous vessels are noted adjacent to the lower pole of the left testis (arrow).

1365.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 21. (a) An axial CT image through the renal areas demonstrating a large right renal mass with invasion of the right renal vein (arrow). (b) A right sided varicocele is demonstrated in the same patient (arrow). (c) Furthermore, an intratesticular varicocele is present, manifest by the presence of serpiginous areas with colour Doppler signal (arrow).

1366.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 22. Hydrocele. Anechoic fluid collection surrounding the testicle.

1367.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 23. Scrotal pearl. Focal extratesticular calcification noted in the tunica vaginalis (arrow). Note the marked posterior acoustic shadowing.

1368.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 24. Microlithiasis. (a) Note that there are more than five foci per transducer field. There is no posterior acoustic shadowing. (b) Florid microlithiasis. More extensive calcification noted compared to the previous patient. Multiple intratesticular foci of increased attenuation with no posterior acoustic shadowing.

1369.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 3. Multifocal seminoma. Multiple well-defined, low reflective lesions present in the testis of a 23-year-old man presenting with scrotal discomfort (arrows).

1370.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 4. Small impalpable seminoma discovered incidentally in a patient with testicular pain in the contralateral testis. There is a well-defined focal peripheral low reflective lesion in the testis which is clearly a solid intratesticular lesion and must be managed as a malignant testicular tumour (arrow).

1371.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 5. Embryonal cell carcinoma. Ill defined low reflective lesion in the testis associated with microlithiasis (between cursors). Note the lack of posterior shadowing related to the microcalcification.

1372.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 6. Teratoma. Predominantly cystic, irregular low reflective lesion in the testis (arrow).

1373.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 7. Leydig cell tumour. There is focal, peripheral, well-defined, low reflective lesion present which appears very similar to the small incidental seminoma demonstrated in Figure 4 (arrow).

1374.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 8. Osteosarcoma metastasis. High reflective multifocal lesion involving most of the testis presenting in a man with advanced metastatic osteosarcoma (arrow).

1375.

Imaging 2005;17:101-112.
Testicular lumps
R Houghton and G Rottenberg
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Figure 9. Testicular metastasis. Focal low reflective lesion associated with high reflective foci occurring in a man undergoing chemotherapy for lung cancer (arrow).

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