The "two-tone" testis: spectrum of ultrasound appearances.

AIM: To determine the prevalence and variation in appearance of the "two-tone" testes artefact. METHODS AND MATERIALS: Patients attending for a testicular ultrasound, without an intra-testicular lesion, were included. A single operator performed examinations using a 15L8w linear array transducer. When an artefact resembling the "two-tone" testes appearance was seen, the images were recorded prospectively. Two independent observers reviewed the images and identified patterns of the two-tone testis as: partial posterior shadowing from an incompletely identified trans-testicular artery; partial posterior shadowing from a completely identified trans-testicular artery; total posterior shadowing from a completely identified trans-testicular artery. RESULTS: Over a 44-month period 1038 patients were examined. The median age of patients was 32.5 years (range 19-46 years). A total of 17 two-tone testes artefacts of varying appearances were identified in 16 patients, occurring in 1.6% of the selected population. There were six partial posterior shadowing from an incompletely identified trans-testicular artery (0.6%); five partial posterior shadowing from a completely identified trans-testicular artery (0.5%); and five total posterior shadowing from a completely identified trans-testicular artery (0.5%) artefacts present. There was no relationship between the two-tone artefact and clinical symptoms or other ultrasound findings. CONCLUSION: The two-tone testis artefact is a rare finding and has a variable appearance according to the extent of acoustic shadowing produced. Careful examination of the testis and operator experience is required when the artefact is identified in order that underlying pathological disease is not overlooked.

Scrotal calcification: ultrasound appearances, distribution and aetiology.

This pictorial review illustrates the ultrasound appearances of scrotal calcification, distinguishing between intratesticular and extratesticular calcification. Intratesticular calcification may be due to phleboliths, spermatic granulomas or vascular calcification, or it may occur in association with tumours. Extratesticular calcification is more frequently encountered and is usually related to previous inflammatory disease of the epididymis. Testicular microlithiasis, a rare condition characterized by multiple scattered echogenic foci within the testis, is produced by the formation of microliths from degenerating cells in the seminiferous tubules. Testicular microlithiasis has been demonstrated as an incidental finding as well as in association with both benign and malignant tumours of the testis.