1.2 Benign Scrotal Pathologies Flashcards
(103 cards)
1
Q
Most Extratesticular masses (within scrotum)
A
Benign
2
Q
Intratesticular masses (inside testicular tissue)
A
Malignant
3
Q
What is a congenital anomaly where the testes are undescended.
*Hint: most common GU abnormality in children
A
Cryptorchidism (benign)
4
Q
Where is the majority of Cryptorchidism located?
A
inguinal canal and palpable (80%)
5
Q
Is Cryptorchidism usually bilateral or unilateral?
A
Unilateral
6
Q
What is the structure that guides and anchors the testes during decent into the scrotal sac?
A
Gubernaculum
7
Q
What 3 factors can interrupt the decent of the testes
A
- Deficiency of Gonadotropin hormone in pregnancy
- Adhesions or anatomic mal-developments that block decent into scrotal sac
- idiopathic
8
Q
Complication of undescended testes (2)
A
- Infertility
2. Testicular cancer (48x)
9
Q
Treatment of undescended testes in children
A
Orchiopexy
before age 2 fertility okay!
10
Q
Treatment of undescended testes in adults
A
Orchiectomy
11
Q
Undescended testes sonographically look like?
A
Oval or elongated mass, smaller, less echogenic, homogenous
12
Q
What will be hard to identify in the Undescended testes
A
Mediastinum
13
Q
What is commonly mistaken for the testicle with Undescended teste?
A
Lymph node (inguinal lymph node)
14
Q
What are 3 other congenital anomalies (rare)?
A
- Polyochidism
- Anorchia
- Testicular Ectopia
15
Q
Polyochidism means?
A
Testicular duplication (extra testicle)
16
Q
Anorchia means?
A
Abcence of a testicle (more common on left)
17
Q
Testicular Ectopia means?
A
Normal R + L Testicle with additional tissue located else where in the body.
18
Q
What is a hydrocele? (benign)
A
Fluid located between the tunica vaginalis layers
19
Q
What does the fluid have to measure to be classified as a hydrocele?
A
> 2mm
20
Q
Where are most hydroceles located?
A
In the Anterolateral scrotum
21
Q
What is the most common sign/symptom of hydrocele
A
PAINLESS SCROTAL SWELLING
22
Q
Hydrocele can be either ____ or ____
A
Congenital
or
Acquired
23
Q
What is a congenital hydrocele?
A
Patent processus vaginalis
usually resolves by 18 months
24
Q
What is a acquired hydrocele?
A
Idiopathic (most)
infection, infarction or
trauma (25%)
25
Small hydroceles are seen in ___ % of patients with testicular tumors.
60%
26
Are large hydroceles associated with neoplasms? yes or no?
NO
27
The sonographic appearance of hydrocele ?
```
variable
anechoic
septations
calcs "scrotal pearls"
debris
```
28
Hematocele is ?
blood in the scrotal sac
| thick scrotal wall, Anechoic, septations, debris, variable appearance
29
Pyocele is?
Pus in the scrotal wall
| absess that burst
thick scrotal wall, Echogenic, variable appearance, possible mural calcifications
30
What is a varicocele
Dilated veins in the pampiniform plexus
| due to obstruct venous return
31
What does the vein have to measure to be classified as a varicocele?
> 2 mm
32
What side are varicoceles typically on?
Left
33
Varicocele can be either ___ or ___ in origin
Primary
or
Secondary
34
What is a primary varicocele?
| Age & cause
15-25 years of age
common cause of correctable infertility
incompetent valves in spermatic vein
35
What is a secondary varicocele?
Pressure on spermatic vein
| usually from mass causing extrinsic pressure
36
Another cause of varicocele? (not in notes)
RCC spreads from kidney to LRV and obstructs drainage of left testicular vein also leads to varicocele
37
What is the "nut cracker syndrome"
Compression of LRV between aorta and SMA
38
What maneuver should you have the patient do is suspect varicocele?
Valsalva or Stand
39
What should happens in a patient with a primary varicocele when Valsalva or Stand?
The vessel should increase in size with valsalva or when stands and return to normal size when stops.
40
What should happens in a patient with a secondary varicocele when Valsalva or Stand?
The vessel has no affect. bc it is due to a mass
41
What is the sonographic feature of a varicocele?
Multiple anechoic structures >2mm
| Normally surrounding testicle
42
What will a varicocele look like with color
| with Valsalva ?
color flow increase
43
What are scrotal Herinas? and what do they contain?
Inguinal hernias that descend into the scrotum usually containing omentum or bowel (look for peristalsis)
44
How do these scrotal herinas usually happen?
Heavy lifting
45
What are signs & symptoms of scrotal herinas (3)
Scrotal enlargement, pain, blood in stool
46
What can trauma of the testicle result in (2)
1. Hematoma
| 2. Hematocele
47
A ruptured testicle is an emergency and is when the ____ tears
Tunica albugina tears
48
What is Torsion
Spermatic cord twists, cut off blood supply to testicle
49
What age is torsion common?
<25 years of age
50
Surgery to salvage the testicle should happen within ___ hours. Complete infarction will happen after __ hours
6; 12
51
what are the 3 stages of torsion and how many days associated with each?
1. Acute - within 24 hours
2. Subacute 1 - 10 days after torsion
3. Chronic after 10 days
52
What are the are 2 types of torsion?
1. Intravaginal (more common) often during puberty
| 2. Extravaginal
53
What is Intravaginal torsion?
Anomalous suspension of teste by long stalk of spermatic cord (long cord)
54
Intravaginal torsion the testes rotate freely within the tunica vaginalis this is known as the ______ deformity
"Bell clapper" deformity
55
When is there an increased incidence of intravaginal torsion?
After orchiopexy
| surgery to fix an undescended testicle
56
What is extravaginal torsion?
Poor/absent attachment of testis to scrotal wall
| Both the tunica vaginalis & spermatic cord twist (torsion)
57
What age is extravaginal torsion more common?
Newborns
58
Intra and Extravaginal torsion both look the same sonographically. T or F
True
59
Stages of the Torsion look sonographically different T or F
True
60
Acute Torsion songraphically (5)
1. Enlarged Testicle and epididymis
2. Testes hypoechoic
3. Thick scrotal skin
4. Reactive hydrocele
5. Absent arterial flow
61
Subacute Torsion songraphically (2)
1. Enlarged Testicle and epididymis
| 2. HETEROGENOUS
62
Chronic Torsion songraphically (2)
1. Testicle will Atrophy (decrease in size)
2. Heterogenous
3. Enlarged epididymis
63
Signs and Symptoms of Torsion
Sudden onset of extreme pain
| N & V
64
Symptoms of Torsion may mimic ____ but diminish after __to___ days
Epididymitis but diminish after 1-2 days
| bc becomes necrotic nerves die
65
Where does infection in the testicles originate from
1. bladder
2. urethra
3. prostate
66
Where is the most common place for infection to originate from ?
The urethra
67
The most common cause of ACUTE scrotal pain in adults is?
Epididymitis
| typically Unilateral
68
What are the S & S of Epididymitis? (4)
1. Fever
2. Pain
3. Dysuria
4. Discharge
69
The sonographic appearance of Epididymitis? (7)
1. Enlarged Epi
2. Hypoechoic/ Heterogenous
3. Scrtoal thickening
4. Hydrocele?
5. Increase blood flow to epi
6. abscess?
7. **with Chronic possible calcs
70
What is Orchitis?
Inflammation of the testies
71
What is Orchitis secondary to ?
Epididymitis
72
The most common cause of orchitis in men <35 is?
Chlamydia
73
Focal Orchitis is described as?
Hypo, mass like, Hypervascular
| sounds like cancer so Doc relies on S&S, it they have the m, probably not cancer
74
Diffuse Orchitis is described as?
Decrease in echogenicity, enlarged
75
Chronic Orchitis is described as?
Hypoechoic, heterogenous, may have reactive hydrocele
76
What is an Abscess?
collection of fluid and debris
| can rupture thru tunica vaginalis
77
What can a Abscess cause
Pyocele or fistula to skin
78
What is the sonographic appearance of an Abscess?
anechoic or complex mass with increased flow in the periphery
79
What are Scrotal pearls?
Calcifications on Tunica or within scrotal sac (OUTSIDE TESTICLE IN SCROTAL SAC)
unknown etiology, MOBILE
80
What is a spermatocele?
Retention cyst. Dilated epididymal tubules filled with non viable sperm
81
What are spermatocele caused by? (2)
Trauma/surgery(vascectomy) or epididymitis
82
Where are spermatocele commonly located?
Epi head
83
Who are spermatocele common in?
Middle aged men.
84
Signs and symptoms of spermatocele
Painless mass, single/multiple/palpable
85
What is the sonographic appearance of spermatocele
Anechoic, well defined, mass, posterior enhancement, cystic structures (simple or septations) may have debris
86
What is the rang of size a spermatocele can be?
0.2-9 cm
87
What are true cysts?
cysts we are born with. Can occur anywhere. Cant differentiate between true cysts and spermatocele
88
What is more common to be seen in the epididymis a true cyst or a spermatocele?
Spermatocele
89
Non-Germ cell Tumors are also known as?
Gonadal stromal
90
The majority of Non-Germ cell Tumors are Benign or Malignant?
Benign
91
Non-Germ cell Tumors affect ages __ to __
20-50 years of age
92
Non-Germ cell Tumors are made of what 2 types of cells?
Leydig
| Steroli
93
Leydig cells may cause?
gynecomastia (breasts in men)
94
Steroli cells may cause?
gynecomastia (breasts in men) and feminization (small testicles)
95
Non-Germ cell Tumors Sonographically?
small, well defined, hypoechoic
96
WHAT IS THE MOST COMMON EXTRATESTICULAR TUMOR? (outside teste tissue)
Adenomatoid Tumor
97
Adenomatoid Tumor typically grow in the ?
Epididymis
98
Adenomatoid Tumor are described as? (3)
Slow growing - Benign
asymptomatic
small
99
Adenomatoid Tumor Sonographically (5)
```
Well defined
variable echogenicity
solid
unilateral
typical on left side
```
100
What is Microlitiasis?
Calcifications within the seminiferous tubules
| multiple tiny echogenic foci
101
Microlitiasis is ______ testicular tissue where Scrotal pearls are _____ testicular tissue in scrotal sac
inside;outside
102
Microlitiasis <5 per transducer field
Benign, incidental finding
103
Microlitiasis >5 per transducer field
Possible malignancy- need to be screen every 6 months
