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Spermatic cord

The spermatic cord is a vital structure in the male reproductive system, extending from the deep inguinal ring to the testis. It contains blood vessels, nerves, lymphatics, and the vas deferens, all of which are enclosed by coverings derived from the abdominal wall during testicular descent. The cord passes through the inguinal canal, making it an important landmark in hernia surgery, urology, and radiology.

Synonyms

  • Funiculus spermaticus

  • Testicular cord

  • Cord of the testis

Origin, Course, and Termination

  • Origin: Begins at the deep inguinal ring, lateral to the inferior epigastric vessels

  • Course:

    • Passes through the inguinal canal, lying superior to the inguinal ligament

    • Emerges at the superficial inguinal ring

    • Descends into the scrotum posterior to the testis

  • Termination: Ends at the posterior border of the testis, where its contents connect with testicular structures

Coverings

Derived from layers of the anterior abdominal wall:

  • External spermatic fascia: from external oblique aponeurosis

  • Cremasteric fascia and cremaster muscle fibers: from internal oblique muscle

  • Internal spermatic fascia: from transversalis fascia

Contents

  • Ductus (vas) deferens

  • Arteries:

    • Testicular artery (from abdominal aorta)

    • Artery to the vas deferens (from superior vesical artery)

    • Cremasteric artery (from inferior epigastric artery)

  • Veins: Pampiniform plexus, draining into the testicular vein

  • Nerves: Genital branch of genitofemoral nerve, sympathetic fibers, and cremasteric nerve

  • Lymphatics: Drain to lumbar (para-aortic) lymph nodes

  • Other: Remnants of processus vaginalis (occasionally)

Relations

  • Anteriorly: Anterior abdominal wall and superficial inguinal ring

  • Posteriorly: Pubic bone, spermatic vessels entering scrotum

  • Medially: Epigastric vessels at origin

  • Laterally: Iliac vessels and abdominal wall

Function

  • Transports sperm from vas deferens to ejaculatory ducts

  • Provides arterial supply and venous drainage to the testis and epididymis

  • Provides lymphatic drainage of testes and epididymis

  • Houses cremaster muscle fibers, aiding in thermoregulation of testes

Clinical Significance

  • Varicocele: Dilatation of pampiniform plexus, seen as “bag of worms” in scrotum

  • Hernia surgery: Spermatic cord is at risk during inguinal hernia repair

  • Tumor spread: Testicular tumors spread along lymphatics within the cord to para-aortic nodes

  • Torsion: Involvement in testicular torsion, compromising vascular supply

  • Infections: Cord may be involved in funiculitis

MRI Appearance

T1-weighted images:

  • Cord structures appear as low-to-intermediate signal tubular elements within bright fat

  • Vas deferens: low signal

  • Vessels: flow voids or intermediate signal

T2-weighted images:

  • Cord structures show intermediate to mildly hyperintense signal compared to muscle

  • Pampiniform plexus veins show hyperintensity when dilated (varicocele)

STIR (Short Tau Inversion Recovery):

  • Normal cord: low-to-intermediate signal

  • Pathology (edema, inflammation, varicocele): bright hyperintensity

T1 Fat-Sat Post-Contrast:

  • Normal vasculature enhances mildly and uniformly

  • Varicocele veins and inflamed cord structures show greater enhancement

  • Tumor or infiltrative disease: heterogeneous or nodular enhancement

3D T2 SPACE / CISS:

  • Cord contents appear as intermediate to mildly hyperintense tubular structures relative to muscle

  • Surrounded by bright fat, aiding visualization of vas deferens and vessels

  • Excellent for mapping cord anatomy and detecting subtle varicoceles or masses

CT Appearance

Non-Contrast CT:

  • Cord appears as a soft tissue density tubular structure surrounded by fat

  • Calcifications or stones (rare) may be identified within vas deferens

  • Varicocele: dilated tubular structures, isodense with blood

Post-Contrast CT:

  • Cord vessels enhance with contrast

  • Pathology (varicocele, infection, tumor) shows more prominent or irregular enhancement

  • Inflammatory fat stranding may be seen around cord in funiculitis

MRI image