Male Pelvis, Prostate Pathologies, and Scrotal Emergencies — WACS Viva & Clinical Scenarios (Genitourinary and Retroperitoneal Imaging)

Exam-style male pelvis, prostate pathologies, and scrotal emergencies viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 16-year-old male presents with sudden-onset, severe left hemiscrotal pain and nausea of 3 hours duration. High-resolution scrotal grayscale and color Doppler ultrasound images demonstrate an enlarged, heterogeneous left testis with a whirlpool sign at the spermatic cord and complete absence of intratesticular vascular flow, alongside normal right testicular perfusion. State the primary diagnosis, interpret the Doppler findings, discuss the significance of the 6-hour time window, and outline the ultrasound features that differentiate complete torsion from partial torsion and spontaneous detor
• SCENARIO 2: A 64-year-old male with an elevated serum PSA of 8.2 ng/mL undergoes multiparametric MRI (mpMRI) of the prostate. Axial T2-weighted, high b-value (b=1500 s/mm²) diffusion-weighted imaging (DWI), ADC maps, and dynamic contrast-enhanced (DCE) images are provided. Describe the PI-RADS v2.1 scoring algorithm for lesions in the peripheral zone versus the transition zone. Detail the specific imaging criteria that indicate extraprostatic extension (EPE), seminal vesicle invasion (SVI), and neurovascular bundle involvement.
• SCENARIO 3: A 22-year-old athlete sustains blunt trauma to the scrotum during a contact sports match. Grayscale ultrasound images demonstrate disruption of the echogenic tunica albuginea, contour irregularity of the right testis, and an associated complex heterogeneous fluid collection within the tunica vaginalis. Provide the definitive diagnosis, identify the key ultrasonographic indicators for immediate surgical exploration versus conservative management, and differentiate a testicular rupture from a simple hematocele or intratesticular hematoma.
• SCENARIO 4: A 32-year-old male presents with a painless, palpable mass in the right hemiscrotum. Scrotal ultrasound reveals a well-circumscribed, homogeneous, hypoechoic intratesticular mass with internal vascularity on color Doppler. Discuss the diagnostic imaging algorithm for solid testicular masses, comparing the classical ultrasound features of seminomas, non-seminomatous germ cell tumors (NSGCTs), sex cord-stromal tumors, and testicular lymphoma. Outline the cross-sectional imaging protocol required for regional and distant oncologic staging.
• SCENARIO 5: Explain the clinical and radiologic significance of Intravesical Prostatic Protrusion (IPP) measured on transabdominal or transrectal ultrasound. Detail the imaging features of acute prostatitis versus prostatic abscess on ultrasound, CT, and MRI, and describe the imaging findings of Fournier gangrene across multiple modalities.