Ultrasound Registry Review (URR) Abdomen Practice Exam

Spermatocele is a cystic dilation of the epididymal tubules, most often in the head of the epididymis, that contains spermatozoa and sediment. This condition frequently appears in men after vasectomy because the vas deferens obstruction leads to accumulation of sperm proximally, causing dilation of the epididymal ducts and the formation of a fluid-filled space that can harbor sperm and debris. On ultrasound, it presents as a well-defined cystic lesion separate from the testis, often with internal echoes from sperm and gravity-dependent sediment; it may show posterior acoustic enhancement and typically no internal vascular flow. This differs from a simple epididymal cyst, which is a fluid-filled, anechoic structure with no sperm content; an intratesticular cyst, which lies within the testicular parenchyma; and an epididymal abscess, which would be more complex, usually have thick walls and surrounding inflammatory changes with increased vascularity on Doppler.