Scrotal Ultrasound and Doppler Report Template: Worked Examples

Scrotal ultrasound report framework

Scrotal ultrasound combines high-frequency grayscale imaging with color or power Doppler. Doppler (color or power and spectral) is required when acute scrotal pain is being evaluated; document arterial and venous flow and use low-flow settings when needed. Compare both testes using appropriate, comparable settings. A volume measurement is a measurement, not a diagnosis; interpret size in age and clinical context. Assess the epididymides, scrotal wall, and spermatic cord when relevant to the indication.

Indication: [Pain, swelling, palpable finding, or other question; side and duration if known]
Comparison: [Date and examination, if available]
Technique: Grayscale and color/power Doppler ultrasound of the scrotum. [Spectral Doppler / standing and Valsalva assessment / inguinal canal assessment, if performed]. [Limitation, if present.]

Findings:
Right testis: [Position, dimensions, volume formula if used, echogenicity, focal lesion, and arterial/venous vascularity.]
Left testis: [Same.]
Right epididymis: [Size, echogenicity, and vascularity.]
Left epididymis: [Same.]
Other scrotal findings: [Hydrocele, varicocele, scrotal wall, spermatic cord, or inguinal canal findings as assessed.]

Impression:
1. [Answer to the clinical question.]
2. [Additional relevant finding or limitation.]

The AIUM 2025 practice parameter specifies evaluation of each testis in longitudinal and transverse planes, comparison of testicular and epididymal size, echogenicity, and blood flow, and assessment of a palpable target. It describes the Lambert formula (length × width × height × 0.71) for volume when used. Follow your local acquisition protocol; not every examination requires the same ancillary assessment.

Normal bilateral example

Fictional teaching case. These findings and measurements are invented and are not reference ranges.

Indication: Intermittent bilateral scrotal discomfort.
Comparison: None available.
Technique: Bilateral scrotal grayscale and color Doppler ultrasound. Both testes were imaged in longitudinal and transverse planes using comparable Doppler settings.

Findings:
The right testis measures 4.5 × 2.4 × 2.8 cm (calculated volume approximately 21 mL using the Lambert formula). The left testis measures 4.3 × 2.4 × 2.7 cm (approximately 20 mL). Both testes are homogeneous, without a focal lesion. Color and spectral Doppler demonstrate symmetric intratesticular arterial and venous flow using comparable low-flow settings.
The epididymides are symmetric and unremarkable. No hydrocele or sonographic varicocele is identified. The scrotal wall is not thickened.

Impression:
Unremarkable bilateral scrotal ultrasound with symmetric testicular vascularity.

Report the dimensions and any calculated volume rather than calling a testis “atrophic” or “enlarged” from an isolated number without the patient’s age, prior studies, and relevant context.

Selected abnormal examples

The cases below are fictional. Wording should describe observed features and preserve uncertainty where findings overlap.

Epididymo-orchitis pattern

Indication: Acute left scrotal pain and swelling.
Comparison: None available.
Technique: Bilateral grayscale and color Doppler scrotal ultrasound with side-by-side comparison.

Findings:
The left epididymis is enlarged and heterogeneous with increased color Doppler vascularity. The left testis is mildly heterogeneous and hyperemic compared with the right. No focal intratesticular collection is identified. A small reactive left hydrocele is present. The right testis and epididymis are unremarkable with preserved flow.

Impression:
Hyperemia and enlargement of the left epididymis with mild testicular involvement, compatible with epididymo-orchitis in the appropriate clinical setting. Small reactive left hydrocele.

Solid intratesticular lesion

Indication: Painless palpable right testicular nodule.
Comparison: None available.
Technique: Bilateral grayscale and color Doppler scrotal ultrasound. The palpable area was directly imaged.

Findings:
Within the upper pole of the right testis is a 1.2 cm solid hypoechoic intratesticular lesion with internal color Doppler flow. The remaining right testicular parenchyma is homogeneous with preserved flow. The left testis is homogeneous without focal lesion. No hydrocele is present.

Impression:
Solid vascular right intratesticular lesion, indeterminate and concerning for neoplasm. Prompt urologic assessment is recommended.
Critical-result communication: [Recipient] notified by [method] at [time], according to local policy.

For a suspected urgent finding, follow the local critical-result pathway and document the recipient, time, and method of communication. Do not label a solid intratesticular lesion benign from ultrasound appearance alone.

Varicocele assessment

Indication: Left scrotal heaviness, worse while standing.
Comparison: None available.
Technique: Bilateral grayscale and color Doppler scrotal ultrasound with additional standing and Valsalva assessment.

Findings:
Both testes are homogeneous with preserved symmetric flow. Multiple serpiginous vessels are present in the left pampiniform plexus and demonstrate increased caliber and reflux with Valsalva while standing. No right-sided varicocele is seen. No hydrocele or focal testicular lesion.

Impression:
Left varicocele demonstrated with standing Valsalva.

If the protocol includes measurements, record the site, position, and maneuver alongside the diameter. Grading systems and diagnostic thresholds vary; do not present a single measurement as a universal cutoff.

Limitations and wording pitfalls

If pain, edema, patient position, or motion limits the examination, specify the affected structure. For example: “The left testis is incompletely assessed because of marked tenderness; intratesticular arterial flow is seen, but comparison is limited.” Do not turn that sentence into a definitive exclusion of torsion.

Partial or intermittent torsion may be missed on ultrasound; a Doppler signal should not be interpreted in isolation as excluding torsion when clinical suspicion remains. Urgent clinical assessment should not be delayed by a reassuring-looking template sentence. The ACR acute scrotal pain criteria support ultrasound as an initial imaging examination, but management remains based on the full clinical situation.

Avoid calling a volume an atrophy diagnosis without context, reporting “normal flow” without comparing sides in acute pain, or describing only the scrotum when an undescended testis or inguinal process is part of the question. For urgent-result documentation principles, see the critical-result communication guide.

References

1. American Institute of Ultrasound in Medicine. Practice Parameter for the Performance of Scrotal Ultrasound Examinations, 2025 Revision. AIUM parameter (opens in a new tab)
2. American College of Radiology. ACR Appropriateness Criteria: Acute Onset of Scrotal Pain—Without Trauma, Without Antecedent Mass, 2024 Update. ACR criteria (opens in a new tab)
3. American Urological Association. Diagnosis and Treatment of Early-Stage Testicular Cancer: Guideline Amendment 2023. AUA guideline (opens in a new tab)

This educational framework does not diagnose torsion, infection, or tumor in a patient. Verify each statement against the full study, symptoms, acquisition, and local escalation pathway.