Male Pelvis Flashcards
(133 cards)
1
Q
____ lines the inner walls the scrotum, covering each testis and epididymis.
A
tunica vaginalis
2
Q
What are the two layers of the tunica vaginalis?
A
parietal (inner lining) and visceral (surrounds epi and testis)
3
Q
Where is the location of hydroceles?
A
hydroceles form in space between layers of tunica vaginalis
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
5
Q
What is the vas deferens?
A
continuation of ductus epididymis
6
Q
The junction of ejaculatory ducts with urethra is called the ____.
A
verumontanum
7
Q
What three sets of veins are in the pampiniform plexus?
A
testicular, deferential, cremasteric
8
Q
What do the testicular veins drain into?
A
right: IVC
left: left renal vein
9
Q
What do the differential veins drain into?
A
pelvic veins
10
Q
What do the cremasteric veins drain into?
A
tributaries of epigastric and deep pudendal veins
11
Q
What may scrotal trauma be a result of?
A
MVA, athletic injury, direct blow to scrotum, straddle injury
12
Q
With trauma, what percentage of the testes can be saved within 72 hours? after 72 hours?
A
up to 90%
only 45%
13
Q
What is the most common cause of painless scrotal swelling?
A
hydrocele
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
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
16
Q
What is a hematocele? What is it associated with?
A
collection of blood associated with trauma, surgery, neoplasms, or torsion
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
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
19
Q
Does the presence of a hematocele confirm rupture?
A
no
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
21
Q
What may a hematoma involve?
A
testis, epididymis, scrotal wall
limited to layers of the tunica vaginalis
22
Q
What indicates a scrotal rupture?
A
blood flow disruption across surface of testis indicates rupture
23
Q
What is the most common cause of acute scrotal pain in adults?
A
epididymo-orchitis
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
25
Describe the sonographic findings of epididymitis-orchitis.
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
26
What may be associated with epididymo-orchitis?
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)
27
With severe epididymo-orchitis, what also may be seen?
pyocele
| occurs when pus fills space between layers of tunica vaginalis
28
What does pyocele appear as sonographically?
usually contains internal septations, loculations, debris; same appearance can occur following trauma or surgery
29
What are the clinical symptoms of pyocele?
fever, elevated white blood cell count
30
How does torsion occur?
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
31
What is the bell clapper deformity?
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
32
What is 10x more likely to be affected by torsion?
undescended testes are 10x more likely than normal testes
33
With torsion, what is affected first? What is the result?
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
34
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?
within 5-6 hours: 80-100%
6-12 hours: 70%
after 12 hours: 20%
35
Peak incidence of torsion occurs at what age?
age 14
36
What are presenting symptoms of torsion?
sudden onset of scrotal pain with swelling on affected side; severe pain causes nausea and vomiting in many patients
37
What is a spermatocele and where does it occur?
cystic dilations of efferent ductules of epididymis; contain proteinaceous fluid and spermatozoa
always located in epididymal head
38
When may spermatoceles be more frequently seen?
following vasectomy
39
What is an epididymal cyst?
small, clear cysts containing serous fluid located within the epididymis
40
What is the difference the appearance of a spermatocele and an epididymal cyst?
the fluid content
| spermatocele will show debris within and the cyst will be close to anechoic
41
What is a varicocele?
abnormal dilation of veins of pampiniform plexus
42
What is a primary and secondary varicocele?
primary: usually caused by incompetent venous valves within spermatic vein
secondary: caused by increased pressure on spermatic vein
43
What condition may be associated with a secondary varicocele?
nutcracker syndrome
| when SMA causes pressure on left renal vein - pressure goes all the way down to plexus where vessels dilate
44
Where is a varicocele the most common?
left side
45
What are some causes of a secondary varicocele?
renal hydronephrosis, abdominal mass, liver cirrhosis, abdominal malignancy invading left renal vein
46
What is the sonographic appearance of a varicocele?
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
47
What is the diameter of the vessels of a varicocele?
greater than 2mm
48
Describe what a scrotal hernia is.
occurs when bowel, omentum, or other structures herniate into scrotum
49
How is a scrotal hernia diagnosed?
clinical diagnosis usually sufficient (turn your head and cough test); sonography helpful in cases of equivocal findings
50
Sonographically, what diagnosis's a scrotal hernia?
peristalsis of the bowel, seen with real time imaging, confirms the diagnosis of a scrotal hernia
51
What is a sperm granuloma?
occur as chronic inflammatory reaction to extravasation of spermatozoa (sperm cells);
may be located anywhere within epididymis or vas deferens
52
What is the incidence of sperm granuloma?
frequently seen in patients with history of vasectomy
53
What is associated with tubular ectasia of the rete testis?
ipsilateral spermatocele, epididymal cyst, testicular cyst, and epididymal obstruction
54
Where is the rete testis located?
located at hilum of testis where mediastinum resides
55
What is the incidence of scrotal cysts? What is it associated with?
more common in men over 40 years old
| associated with extratesticular spermatoceles
56
Where are scrotal cysts located?
near the mediastinum
57
What is associated with microlithasis?
testicular malignancy, cryptorchidism, klinefelter's syndrome, infertility, varicoceles, testicular atrophy, and male psudohermaphroditism
58
What are the sonographic appearance of microlithasis?
microcalcifications are < 3mm
| usually bilateral
59
What is the incidence for testicular malignancy?
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
What are the symptoms of malignant testicular masses?
painless lump, testicular enlargement, or vague discomfort in scrotum
61
With intra and extratesticular masses, which is more likely to be malignant?
extratesticular masses are usually benging
| intratesticular masses more likely to be malignant
62
What are the two categories of testicular tumors? Describe each.
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
What are the most common types of germ cell tumors?
seminoma, mixed embryonal cell tumors, and teratocarcinomas
64
What is the sonographic appearance of seminomas?
homogeneous, hypoechoic, and smooth borders (does not contain calcs or cystic components)
65
What is the sonographic appearance of embryonal cell carcinoma?
heterogeneous and less well circumscribed
may contain areas of increased echogenicity resulting from calcification, hemorrhage, or fibrosis
(more aggressive than seminomas)
66
What is the sonographic appearance of choriocarcinoma?
varied appearance
| typically has irregular borders
67
Primary tumor of testicular metastasis may be from:
prostate, kidneys, and less commonly - lung, pancreas, bladder, colon, thyroid, or melanoma
68
What are the sonographic findings of testicular metastasis?
solid hypoechoic mass, hyperechoic, mixture of both
69
What is the most common bilateral secondary testicular neoplasm affecting men older than 60 years?
testicular lymphoma
70
What is the second most common secondary testicular neoplasm? Where is it commonly found?
leukemia
| most often found in children
71
What is the sonographic appearance of testicular lymphoma and leukemia?
testicle may be enlarged or bilateral/unilateral
72
What is cryptorchidism?
undescended testes
| bilateral in 10-25% of cases
73
Where are undescended testes usually located?
abdomen, inguinal canal (more common), other ectopic location
74
What is the sonographic appearance of cryptorchidism?
undescended testis will be smaller and less echogenic than normal testis
usually oval with homogeneous texture
75
What is testicular ectopia?
ectopic testicle cannot be manipulated into correct path of descent
76
What is the most common site for ectopic testicle?
superficial inguinal pouch
77
Where may an ectopic testicle be located?
perineum, femoral canal, suprapubic area, penis, diaphragm, and other scrotal compartment
78
Which side is more common for anorchia?
left side
79
What are causes of anorchia?
intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero
80
Which side is more common for polyorchidism?
left side
81
Those with polyorchidism has an increased incidence of what?
malignancy, crytorchidism, inguinal hernia, torsion with polyorchidism
82
Where is testicular duplication usually found?
in scrotum, also been found in inguinal canal or retroperitoneum
83
Is/are the duplicated testis functional?
no; non-functioning
84
What are clinical findings of prostitis?
high fever, malaise, rectal pain, perineal pain, and warm, tender prostate on DRE
85
What is the cause of prostitis?
E. Coli infection
86
Sonographically, prostitis appears as...
enlarged, rounded, decreased echogenicity, focal hypoechoic areas
calcifications present in chronic cases
87
If prostitis is untreated, what can it lead to?
prostate abscess
88
What is the sonographic appearance of a prostatic abscess?
hypoechoic focal areas representing inflammatory filtrates progressing to anechoic, complex
89
What is benign prostatic hypertrophy?
formation and contunied growth of peri-urethral and transition zone stromal nodules
these nodules compress the fibroglandular peripheral zone
90
What is the incidence for benign prostatic hypertrophy?
occurs later in life
91
What can severe BPH result in?
bladder outlet obstruction with subsequent UTI or stone formation
92
What does BPH look like sonographically?
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
What is the most common malignancy in men?
prostate malignancy
94
Where do a majority of prostatic malignancies arise?
in the central and peripheral zones
95
What is the sonographic appearance of prostate malignancy?
hypo to isoechoic, commonly multi-focal, increased vascularity, increased stiffness on elastography
(frequently starts as BPH)
96
What is the testis covered by?
tunica albugiea
97
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
b. two layers of the tunica vaginalis
98
“Bell clapper” is another term used to describe which of the following abnormalities?
a. hydrocele
b. microcalcifications
c. testicular torsion
d. cryptorchidism
c. testicular torsion
99
```
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. 6 months of age
100
```
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
```
c. anterior aspect of the abdominal aorta
101
```
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
```
d, produces ejaculation fluid
102
```
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
```
d. verumontanum
103
```
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
```
c. spermatocele
104
```
The scrotum is divided into two separate com-partments by the:
a.
medium raphe
b.
tunica vaginalis
c.
mediastinum testis
d.
spermatic cord
```
a. medium raphe or septum
105
What is the most common cause of male infertility?
varicoceles
106
```
The epididymis connects to the testis by which of the following structures?
a.
medium raphe
b.
vas deferens
c.
rete testis
d.
spermatic cord
```
c. rete testis
107
```
Which of the following pathologies is the most common cause of acute scrotal pain?
a.
orchitis
b.
varicocele
c.
epididymitis
d.
testicular torsion
```
c. epididymitid
108
What may a woman get a breast ultrasound?
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
What are the three layers of tissue in the breast?
subcutaneous, fat (hypoechoic and lobular; structional portion of breast), and mammary (functional portion of breast)
110
Describe the sonographic apppearance of the boundaries of the breast, areolar area, and internal nipple.
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
What may be the reason to do an ultrasound on a lactating woman?
clogged duct, palpable mass, mastitis, and abscess
112
What are the main arterial supply to the breast? Venous drainage?
arterial: internal mammary and lateral thoracic
venous: superficial veins
113
What is the primary function of the breast?
fluid transport
| ductal system is critical for this
114
Where does lymphatic drainage go to?
flows to the axillary lymph nodes
115
When do breast cancer screenings begin?
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
What are clinical signs and symptoms of breast cancer?
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
List primary signs of breast cancer on mammography.
irregular (spiculated), high density mass; clustered pleomorphic microcalcifications; focal distortions
less commonly: focal asymmetric density; developing density
118
List seconday signs of breast cancer on mammography.
nipple or skin retration, skin thickening, lymphedema pattern, increased vascularity
119
What are risk factors for breast cancer?
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
When a breast problem is encountered, what is to be determined with breast evaluation?
location of mass (clock face/quadrant) and characteristics of the mass (size, shape, surface contour, consistency, mobility)
121
What are the sonographic characteristics for the margins of a solid breast lesion?
benign: smooth, rounded
malignant: indistinct, fuzzy, spiculated
122
What are the sonographic characteristics for the breast architexture of a solid breast lesion?
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
What are the sonographic characteristics for the shape of a solid breast lesion?
benign: rounded or oval, large lobulations, wider than tall
malignant: sharp/angular, microlobulations, taller than wide
124
What are the sonographic characteristics for the internal echo pattern of a solid breast lesion?
benign: isoechoic, hyperechoic; posterior enhancement
malignant: hypoechoic, week internal echoes, clustered microcalcifications; strongly attenuating
125
What are the sonographic characteristics for the mobility, compressibility, and vascularity of a solid breast lesion?
benign: some mobility; fatty tumors usually compressable
malignant: firmly fixed; rigid, noncompressible; hypervascular, feeder vessel
126
What breast pathology is benign?
cyst, fibrosystic condition, fibroadenoma, lipoma, fat necrosis, acute mastitis, chronic mastitis, abscess, cystosarcoma phyllodes, intraductal papilloma
127
What are risk factors with males for breast cancer?
klinefelter syndrome, male-to-female transsexual, history of chest wall irradiation, history of orchitis or testicular tumor, liver disease, genetic predisposition
128
What breast pathology is malignant?
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
When does the appearance of the lung change?
when air space is diminished
130
What does interstitial syndrome look like sonographically? With what pathologies is it linked to?
sonographically vertical echogenic lines are seen due to extra fluid
linked with cardiogenic edema, acute respiratory distress syndrome, pulmonary fibrosis
131
What is a consolidated lung?
massive loss of air in lung spaces
| fluid filled aveoli allow visualization of lung tissue
132
What pathologies is a consolidated lung associated with?
pneumonia, infarctions, pulmonary embolism, contusions, obstructive or compressive atelectasis
133
What is pleural effusion?
fluid build up around the lung
