Sonographic Features of Vasectomy-Related Changes and Abnormalities in the Scrotum

This article presents changes in the testis and epididymis after a vasectomy as well as illustrate the various vasectomy-related abnormalities on sonographic examination. In patients with scrotal pain after a recent vasectomy, the sonographic findings include enlargement of the epididymis with an ill-defined border and hematoma, or a hematocele surrounding the testis and epididymis. Vasectomy-related changes are likely attributable to post-vasectomy obstructive changes and increased intraluminal pressure in the efferent ducts, epididymides, and vas deferens. The typical sonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. Spermatoceles display various sonographic findings, from multilocular cysts, to cystic lesions with low-echo levels, to a solid mass. Sperm granulomas appear as well-circumscribed heterogeneous masses on sonography and are commonly found at the epididymis or the ends of the severed vas deferens. The hydrocele, varicocele, epididymal cysts, and testicular cysts can also be associated; however, these findings are nonspecific. When radiologists encounter abnormalities of the scrotum, it would be useful to obtain a history of vasectomy to enable a correct diagnosis. Understanding of sonographic features of vasectomy-related changes and abnormalities is essential for correct diagnosis and proper management.