What is Normal

A normal testicle will be ovoid shaped with a vertical lie. The echogenicity on gray scale US should be uniform and homogonous. You should see the tunica albuginea lining the outside of the testicle as a thin, hyperechoic rim. The mediastinum testis is a hyperechoic band crossing the center of the testicle, best seen in the longitudinal view (Figure 3); however, it may not always be visible, and in the setting of trauma, it can be mistaken for pathology. The epididymis is seen adjacent to the testis and is slightly hypoechoic relative to the testis (figure 4).  In color flow doppler, the testicles should have blood flow equal bilaterally. Look for presence of arterial blood flow in the center of the testicle (Figure 5).

 

Figure 3. Normal testicles in longitudinal view. The arrows are pointing to the mediastinum testis which is a normal finding. The arrowheads are outlining the tunica albuginea [13]

 

Figure 4. Normal testicles in transverse view

 

Figure 5. Color flow doppler of normal testicle in longitudinal view

 

Video 1: Normal color doppler of the left testicle. Video courtesy of David Kirschner, used with permission.