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Abdomen > Male Pelvis > Flashcards

Male Pelvis Flashcards

1
Q

____ lines the inner walls the scrotum, covering each testis and epididymis.

A

tunica vaginalis

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2
Q

What are the two layers of the tunica vaginalis?

A

parietal (inner lining) and visceral (surrounds epi and testis)

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3
Q

Where is the location of hydroceles?

A

hydroceles form in space between layers of tunica vaginalis

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4
Q

What is the bare area? What is located there?

A

posterior area where testicle is against scrotal wall (preventing torsion)
blood vessels, lymphatics, nerves, spermatic ducts travel through area

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5
Q

What is the vas deferens?

A

continuation of ductus epididymis

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6
Q

The junction of ejaculatory ducts with urethra is called the ____.

A

verumontanum

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7
Q

What three sets of veins are in the pampiniform plexus?

A

testicular, deferential, cremasteric

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8
Q

What do the testicular veins drain into?

A

right: IVC
left: left renal vein

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9
Q

What do the differential veins drain into?

A

pelvic veins

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10
Q

What do the cremasteric veins drain into?

A

tributaries of epigastric and deep pudendal veins

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11
Q

What may scrotal trauma be a result of?

A

MVA, athletic injury, direct blow to scrotum, straddle injury

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12
Q

With trauma, what percentage of the testes can be saved within 72 hours? after 72 hours?

A

up to 90%

only 45%

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13
Q

What is the most common cause of painless scrotal swelling?

A

hydrocele

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14
Q

What may be the cause of a hydrocele? What fluid does it contain?

A

ideopathic, but commonly associated with epididymo-orchitis and torsion
contains serous fluid

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15
Q

What is a pyocele? How dpes it occur?

A

a collection of pus

occurs with untreated infection or when an abscess ruptures into space between layers of tunica vaginalis

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16
Q

What is a hematocele? What is it associated with?

A

collection of blood associated with trauma, surgery, neoplasms, or torsion

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17
Q

What is the sonographic appearace of a scrotal rupture?

A

focal alteration of testicular parenchymal pattern, interuption of tunica albuginea, irregular testicular contour, scrotal wall thickening, hematocele

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18
Q

What is the sonographic appearance of a hematocele?

A

varies with age of injury
acute: echogenic, numerous and highly visible echoes that can be seen to float or move in real time
old injury: low level echoes, develop fluid fluid levels or septations

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19
Q

Does the presence of a hematocele confirm rupture?

A

no

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20
Q

What is the sonographic appearace of a hematoma?

A

may be large and cause displacement of the associated testis, heterogeneous areas within scrotum, become more complex with time and developing cystic components

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21
Q

What may a hematoma involve?

A

testis, epididymis, scrotal wall

limited to layers of the tunica vaginalis

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22
Q

What indicates a scrotal rupture?

A

blood flow disruption across surface of testis indicates rupture

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23
Q

What is the most common cause of acute scrotal pain in adults?

A

epididymo-orchitis

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24
Q

What is epididymo-orchitis? What does it result from?

A

infection of epididymis and testis
most commonly results from spread of lower urinary tract infection via spermatic cord
usually occurs secondary to epididymitis

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25
Q

Describe the sonographic findings of epididymitis-orchitis.

A

epidiymitis appears as enlarged, hypoechoic, gland; if secondary hemorrhage has occurred, epididymitis may contain focal hyperechoic areas; hyperemic flow confirmed with color Doppler and low resistive flow

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26
Q

What may be associated with epididymo-orchitis?

A

scrotal wall thickening, hydrocele
(complex hydroceles may be associated with severe epididymitis and orchitis)
swelling may be seen and can cause obstruction to testicular blood supply - appears as decreased flow, high resistance with little or no diastolic flow (severe: also reversal of blood flow)

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27
Q

With severe epididymo-orchitis, what also may be seen?

A

pyocele

occurs when pus fills space between layers of tunica vaginalis

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28
Q

What does pyocele appear as sonographically?

A

usually contains internal septations, loculations, debris; same appearance can occur following trauma or surgery

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29
Q

What are the clinical symptoms of pyocele?

A

fever, elevated white blood cell count

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30
Q

How does torsion occur?

A

occurs as a result of abnormal mobility of testis within scrotum; testis and epididymis twist within scrotum, cutting off vascular supply within spermatic cord
can occur due to Bell clapper deformity

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31
Q

What is the bell clapper deformity?

A

tunica vaginalis completely surrounds the testis, epididymis, and digital spermatic cord (tunica vaginalis should not cover anything but a majority of the testes) allowing them to move and rotate freely within the scrotum

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32
Q

What is 10x more likely to be affected by torsion?

A

undescended testes are 10x more likely than normal testes

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33
Q

With torsion, what is affected first? What is the result?

A

venous flow affected first with occluded veins, causing swelling of scrotal structures on affected side
if torsion continues, arterial flow obstructed and testicular ischemia follows

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34
Q

What is the salvage rate of torsion if surgery is performed within 5-6 hours of onset of pain? 6-12 hours? After 12 hours?

A

within 5-6 hours: 80-100%
6-12 hours: 70%
after 12 hours: 20%

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35
Q

Peak incidence of torsion occurs at what age?

A

age 14

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36
Q

What are presenting symptoms of torsion?

A

sudden onset of scrotal pain with swelling on affected side; severe pain causes nausea and vomiting in many patients

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37
Q

What is a spermatocele and where does it occur?

A

cystic dilations of efferent ductules of epididymis; contain proteinaceous fluid and spermatozoa
always located in epididymal head

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38
Q

When may spermatoceles be more frequently seen?

A

following vasectomy

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39
Q

What is an epididymal cyst?

A

small, clear cysts containing serous fluid located within the epididymis

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40
Q

What is the difference the appearance of a spermatocele and an epididymal cyst?

A

the fluid content

spermatocele will show debris within and the cyst will be close to anechoic

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41
Q

What is a varicocele?

A

abnormal dilation of veins of pampiniform plexus

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42
Q

What is a primary and secondary varicocele?

A

primary: usually caused by incompetent venous valves within spermatic vein
secondary: caused by increased pressure on spermatic vein

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43
Q

What condition may be associated with a secondary varicocele?

A

nutcracker syndrome

when SMA causes pressure on left renal vein - pressure goes all the way down to plexus where vessels dilate

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44
Q

Where is a varicocele the most common?

A

left side

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45
Q

What are some causes of a secondary varicocele?

A

renal hydronephrosis, abdominal mass, liver cirrhosis, abdominal malignancy invading left renal vein

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46
Q

What is the sonographic appearance of a varicocele?

A

numerous tortuous tubes of varying sizes within spermatic cord near epididymal head; tubes may contain echoes that move with real-time imaging; increase diameter in response to valsalva

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47
Q

What is the diameter of the vessels of a varicocele?

A

greater than 2mm

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48
Q

Describe what a scrotal hernia is.

A

occurs when bowel, omentum, or other structures herniate into scrotum

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49
Q

How is a scrotal hernia diagnosed?

A

clinical diagnosis usually sufficient (turn your head and cough test); sonography helpful in cases of equivocal findings

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50
Q

Sonographically, what diagnosis’s a scrotal hernia?

A

peristalsis of the bowel, seen with real time imaging, confirms the diagnosis of a scrotal hernia

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51
Q

What is a sperm granuloma?

A

occur as chronic inflammatory reaction to extravasation of spermatozoa (sperm cells);
may be located anywhere within epididymis or vas deferens

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52
Q

What is the incidence of sperm granuloma?

A

frequently seen in patients with history of vasectomy

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53
Q

What is associated with tubular ectasia of the rete testis?

A

ipsilateral spermatocele, epididymal cyst, testicular cyst, and epididymal obstruction

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54
Q

Where is the rete testis located?

A

located at hilum of testis where mediastinum resides

55
Q

What is the incidence of scrotal cysts? What is it associated with?

A

more common in men over 40 years old

associated with extratesticular spermatoceles

56
Q

Where are scrotal cysts located?

A

near the mediastinum

57
Q

What is associated with microlithasis?

A

testicular malignancy, cryptorchidism, klinefelter’s syndrome, infertility, varicoceles, testicular atrophy, and male psudohermaphroditism

58
Q

What are the sonographic appearance of microlithasis?

A

microcalcifications are < 3mm

usually bilateral

59
Q

What is the incidence for testicular malignancy?

A

most common malignancy in men between ages of 15 and 25
most frequently occurs between ages 20 and 34
undescended testes are 2.5 to 8 times more likely to develop cancer

60
Q

What are the symptoms of malignant testicular masses?

A

painless lump, testicular enlargement, or vague discomfort in scrotum

61
Q

With intra and extratesticular masses, which is more likely to be malignant?

A

extratesticular masses are usually benging

intratesticular masses more likely to be malignant

62
Q

What are the two categories of testicular tumors? Describe each.

A

germ cell and non germ cell tumors
germ cell tumors (95% and highly malignant) are associated with elevated level of hCG and AFP
non germ cell tumors are generally benign

63
Q

What are the most common types of germ cell tumors?

A

seminoma, mixed embryonal cell tumors, and teratocarcinomas

64
Q

What is the sonographic appearance of seminomas?

A

homogeneous, hypoechoic, and smooth borders (does not contain calcs or cystic components)

65
Q

What is the sonographic appearance of embryonal cell carcinoma?

A

heterogeneous and less well circumscribed
may contain areas of increased echogenicity resulting from calcification, hemorrhage, or fibrosis
(more aggressive than seminomas)

66
Q

What is the sonographic appearance of choriocarcinoma?

A

varied appearance

typically has irregular borders

67
Q

Primary tumor of testicular metastasis may be from:

A

prostate, kidneys, and less commonly - lung, pancreas, bladder, colon, thyroid, or melanoma

68
Q

What are the sonographic findings of testicular metastasis?

A

solid hypoechoic mass, hyperechoic, mixture of both

69
Q

What is the most common bilateral secondary testicular neoplasm affecting men older than 60 years?

A

testicular lymphoma

70
Q

What is the second most common secondary testicular neoplasm? Where is it commonly found?

A

leukemia

most often found in children

71
Q

What is the sonographic appearance of testicular lymphoma and leukemia?

A

testicle may be enlarged or bilateral/unilateral

72
Q

What is cryptorchidism?

A

undescended testes

bilateral in 10-25% of cases

73
Q

Where are undescended testes usually located?

A

abdomen, inguinal canal (more common), other ectopic location

74
Q

What is the sonographic appearance of cryptorchidism?

A

undescended testis will be smaller and less echogenic than normal testis
usually oval with homogeneous texture

75
Q

What is testicular ectopia?

A

ectopic testicle cannot be manipulated into correct path of descent

76
Q

What is the most common site for ectopic testicle?

A

superficial inguinal pouch

77
Q

Where may an ectopic testicle be located?

A

perineum, femoral canal, suprapubic area, penis, diaphragm, and other scrotal compartment

78
Q

Which side is more common for anorchia?

A

left side

79
Q

What are causes of anorchia?

A

intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero

80
Q

Which side is more common for polyorchidism?

A

left side

81
Q

Those with polyorchidism has an increased incidence of what?

A

malignancy, crytorchidism, inguinal hernia, torsion with polyorchidism

82
Q

Where is testicular duplication usually found?

A

in scrotum, also been found in inguinal canal or retroperitoneum

83
Q

Is/are the duplicated testis functional?

A

no; non-functioning

84
Q

What are clinical findings of prostitis?

A

high fever, malaise, rectal pain, perineal pain, and warm, tender prostate on DRE

85
Q

What is the cause of prostitis?

A

E. Coli infection

86
Q

Sonographically, prostitis appears as…

A

enlarged, rounded, decreased echogenicity, focal hypoechoic areas
calcifications present in chronic cases

87
Q

If prostitis is untreated, what can it lead to?

A

prostate abscess

88
Q

What is the sonographic appearance of a prostatic abscess?

A

hypoechoic focal areas representing inflammatory filtrates progressing to anechoic, complex

89
Q

What is benign prostatic hypertrophy?

A

formation and contunied growth of peri-urethral and transition zone stromal nodules
these nodules compress the fibroglandular peripheral zone

90
Q

What is the incidence for benign prostatic hypertrophy?

A

occurs later in life

91
Q

What can severe BPH result in?

A

bladder outlet obstruction with subsequent UTI or stone formation

92
Q

What does BPH look like sonographically?

A

course echotexture, hypoechoic, diffuse or nodular enlargement of the inner gland, occasional hypoechoic rimming is seen, focal areas may rarely be iso or hyperechoic

93
Q

What is the most common malignancy in men?

A

prostate malignancy

94
Q

Where do a majority of prostatic malignancies arise?

A

in the central and peripheral zones

95
Q

What is the sonographic appearance of prostate malignancy?

A

hypo to isoechoic, commonly multi-focal, increased vascularity, increased stiffness on elastography
(frequently starts as BPH)

96
Q

What is the testis covered by?

A

tunica albugiea

97
Q

A hydrocele is defined as an abnormal fluid collection between the:

a. tunica albuginea and the tunica vaginalis
b. two layers of the tunica vaginalis
c. spermatic cord and the tunica vaginalis
d. two layers of the tunica albuginea

A

b. two layers of the tunica vaginalis

98
Q

“Bell clapper” is another term used to describe which of the following abnormalities?

a. hydrocele
b. microcalcifications
c. testicular torsion
d. cryptorchidism

A

c. testicular torsion

99
Q 
Normal testes will descend into the scrotal sac by:
 a.
6 months of age
 b.
12 months of age
 c.
2 years of age
 d.
3 years of age
A

a. 6 months of age

100
Q 
Which of the following arteries gives rise to the testicular arteries?
 a.
common iliac arteries
 b.
internal iliac arteries
 c.
anterior aspect of the abdominal aorta
 d.
lateral aspect of the abdominal aorta
A

c. anterior aspect of the abdominal aorta

101
Q 
Which of the following functions is considered a responsibility of the prostate gland?
 a.
stores sperm
 b.
matures sperm
 c.
germinates sperm
 d.
produces ejaculation fluid
A

d, produces ejaculation fluid

102
Q 
Which of the following structures divides the male urethra into proximal and distal segments?
 a.
seminal vesicles
 b.
surgical capsule
 c.
vas deferens
 d.
verumontanum
A

d. verumontanum

103
Q 
An anechoic structure arising from the rete testes describes which of the following structures?
 a.
epididymal cyst
 b.
testicular cyst
 c.
spermatocele
 d.
prostate cyst
A

c. spermatocele

104
Q 
The scrotum is divided into two separate com-partments by the:
 a.
medium raphe
 b.
tunica vaginalis
 c.
mediastinum testis
 d.
spermatic cord
A

a. medium raphe or septum

105
Q

What is the most common cause of male infertility?

A

varicoceles

106
Q 
The epididymis connects to the testis by which of the following structures?
 a.
medium raphe
 b.
vas deferens
 c.
rete testis
 d.
spermatic cord
A

c. rete testis

107
Q 
Which of the following pathologies is the most common cause of acute scrotal pain?
 a.
orchitis
 b.
varicocele
 c.
epididymitis
 d.
testicular torsion
A

c. epididymitid

108
Q

What may a woman get a breast ultrasound?

A

further evaluation of mammographic masses, evaulation of a palpable breast lump, young patient with dense breast, pregnant or lactating patient, patient with breast augmentation, difficult or compromised mammogram, and/or image guided procedures

109
Q

What are the three layers of tissue in the breast?

A

subcutaneous, fat (hypoechoic and lobular; structional portion of breast), and mammary (functional portion of breast)

110
Q

Describe the sonographic apppearance of the boundaries of the breast, areolar area, and internal nipple.

A

boundaries: strong, bright echo reflections (skin line, nipple, retromammary layer)
areolar: slightly lower echo reflection than nipple and skin
internal nipple: variable; low-to-bright reflections with posterior shadowing

111
Q

What may be the reason to do an ultrasound on a lactating woman?

A

clogged duct, palpable mass, mastitis, and abscess

112
Q

What are the main arterial supply to the breast? Venous drainage?

A

arterial: internal mammary and lateral thoracic
venous: superficial veins

113
Q

What is the primary function of the breast?

A

fluid transport

ductal system is critical for this

114
Q

Where does lymphatic drainage go to?

A

flows to the axillary lymph nodes

115
Q

When do breast cancer screenings begin?

A

BSE: monthly starting at 20 years old
clinical breast examination: every 3 years from 20-39 and annually after that
screening mammogram: 45-54 annually and bi-annually after that

116
Q

What are clinical signs and symptoms of breast cancer?

A

new or growingg dominant, discrete breast lump, usually painless, does not funtuate with hormonal cycle; up to 5% can occur outside the reach of mammo, distinguish from lumpy breast texture; unilateral single duct nipple discharge, spontaneous, persistent discharge - serous or bloody; surface nipple lesions; non-healing ulcer; focal irritation; new nipple retraction, new focal skin dimpling or tretraction; unilateral new or growing axillary lump; hot, red breast

117
Q

List primary signs of breast cancer on mammography.

A

irregular (spiculated), high density mass; clustered pleomorphic microcalcifications; focal distortions
less commonly: focal asymmetric density; developing density

118
Q

List seconday signs of breast cancer on mammography.

A

nipple or skin retration, skin thickening, lymphedema pattern, increased vascularity

119
Q

What are risk factors for breast cancer?

A

female gender, increasing age, family or personal history of breast cancer, premonopausal breast cancer, associated cancers (colon, ovarian, prostate), biopsy proven atypical proliferative lesions, lobular neoplasia, atypical epithelial hyperplasia, prolonged estrogen effect, early menarche, late menopause, nulliparity, late first pregnancy

120
Q

When a breast problem is encountered, what is to be determined with breast evaluation?

A

location of mass (clock face/quadrant) and characteristics of the mass (size, shape, surface contour, consistency, mobility)

121
Q

What are the sonographic characteristics for the margins of a solid breast lesion?

A

benign: smooth, rounded
malignant: indistinct, fuzzy, spiculated

122
Q

What are the sonographic characteristics for the breast architexture of a solid breast lesion?

A

benign: grows within tissue causing compression of tissue adjacent to mass
malignant: grows through tissue without compressing adjacent tissue; may cause retraction of the nipple or dimpling of the skin

123
Q

What are the sonographic characteristics for the shape of a solid breast lesion?

A

benign: rounded or oval, large lobulations, wider than tall
malignant: sharp/angular, microlobulations, taller than wide

124
Q

What are the sonographic characteristics for the internal echo pattern of a solid breast lesion?

A

benign: isoechoic, hyperechoic; posterior enhancement
malignant: hypoechoic, week internal echoes, clustered microcalcifications; strongly attenuating

125
Q

What are the sonographic characteristics for the mobility, compressibility, and vascularity of a solid breast lesion?

A

benign: some mobility; fatty tumors usually compressable
malignant: firmly fixed; rigid, noncompressible; hypervascular, feeder vessel

126
Q

What breast pathology is benign?

A

cyst, fibrosystic condition, fibroadenoma, lipoma, fat necrosis, acute mastitis, chronic mastitis, abscess, cystosarcoma phyllodes, intraductal papilloma

127
Q

What are risk factors with males for breast cancer?

A

klinefelter syndrome, male-to-female transsexual, history of chest wall irradiation, history of orchitis or testicular tumor, liver disease, genetic predisposition

128
Q

What breast pathology is malignant?

A

ductal carcinoma in situ, invasive ductal carcinoma, lobular carcinoma in situ, invasive lobular carcinoma - four main offenders
comedocarcinoma, juvenile breast cancer, papillary carcinoma, paget’s disease, scirrhous carcinoma, medullary carcinoma, colloid carcinoma, tubular carcinoma

129
Q

When does the appearance of the lung change?

A

when air space is diminished

130
Q

What does interstitial syndrome look like sonographically? With what pathologies is it linked to?

A

sonographically vertical echogenic lines are seen due to extra fluid
linked with cardiogenic edema, acute respiratory distress syndrome, pulmonary fibrosis

131
Q

What is a consolidated lung?

A

massive loss of air in lung spaces

fluid filled aveoli allow visualization of lung tissue

132
Q

What pathologies is a consolidated lung associated with?

A

pneumonia, infarctions, pulmonary embolism, contusions, obstructive or compressive atelectasis

133
Q

What is pleural effusion?

A

fluid build up around the lung

Abdomen (4 decks)

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