This case is presented to show the ultrasound appearance of a spermatocele.

A spermatocele is a benign clear fluid-filled cyst that may arise in any part of the epididymis and contains non-viable sperm. A spermatocele is usually asymptomatic but sometimes produces palpable masses that may cause discomfort to the patient. It is more common in older men. 

No definitive casuative factor for spermatocele has been established. The sperm passes through the epididymis where it undergoes maturation. One theory that has been postulated in the pathogenesis of a spermatocele is that with advancing age, the seminiferous epithelium degenerates and the germ cells that are shed accumulate and block the efferent ducts, resulting in sterile cystic collections within the epididymis.

Ultrasound appearance:
1. Spermatoceles may be single or multiple, unilateral or bilateral.
2. Commonly located in the epididymal head, however they can also be seen in the body and tail. 
3. They appear as well-defined hypoechoic or cystic structures that show significant posterior enhancement.
4. Internal septations may be present in the cysts.

Role of ultrasound:
1. To establish a diagnosis and distinguish from other intrascrotal lesions such as a varicocele, hydrocele or a simple epididymal cyst.
2. Ultrasound guided therapeutic aspiration of a multilocular spermatocele may be performed to obtain relief of symptoms.

This patient refused any form of treatment and follow up scrotal ultrasound revealed no change in the spermatoceles.