Male reproductive system Flashcards

Question

3 A 42 year old man presents with a non-tender testicular lump. On examination he is noted to have gynaecorriastia. The B-HCG, a-fetoprotein and lactate dehydrogenase levels are within normal limits. US demonstrates an irregular hypoechoic nodule. What is the most likely diagnosis? (a) Choriocarcinoma (b) Leydig cell tumour (c) Lymphoma (d) Seminoma (e) Yolk sac tumour

Answer 1

(b) Leydig cell tumour Leydig cell tumours represent 1-3% of all testicular cancers, and are most common in men aged 30-60 years. They are stromal tumours, which form in the interstitial tissues that support the testes. The Leydig cells produces hormones, thus such tumours are typically hormonally active and lead to feminising or virilising syndromes; 30% secrete estradiol, resulting in gynaecomastia. B-HCG, AFP and LDH levels are typically normal (B-HCG is 'always' raised in choriocarcinoma and in 83% of seminomas; AFP is raised in >90% of yolk sac tumours).

Answer 2

(d) Antibiotic prophylaxis is mandatory for transrectal prostate biopsies Elevated PSA or an abnormal DRE are indications for biopsy in asymptomatic men. The sextant biopsy protocol has now been found to give too many false negatives and has been largely replaced by extended core protocols. Local anaesthesia and antibiotic cover are now standard care. A 5-7.5 MHz probe is usually used.

Answer 3

(e) Heterogeneous enhancement with cystic change is typical Sarcoma of the prostate is a rare tumour characterized by a large heterogeneous enhancing mass. Rhabdomyosarcoma is more commonly seen in children; leiomyosarcoma more commonly in adults. The PSA is not usually affected due to the lack of epithelial involvement.

Answer 4

(c) Serial CT In recent times imaging surveillance of the retroperitoneum after surgery has been developed as an acceptable strategy to reduce the chance of subsequent morbidity and mortality. CT currently remains the modality most commonly used, although concerns have been raised regarding the radiation dose in this group of young patients. This has led to potential interest in MRI but as yet, this has not been widely dopted.

Answer 5

(c) CT is the best test to investigate the extent of spread Fournier's gangrene is a rapidly spreading necrotizing fasciitis that involves the genital or peri-anal regions. It usually has an identifiable predisposing event. It is polymicrobial in origin with E. coli being the commonest identifiable organism. CT is the best investigation for assessing the degree of spread, and can identify complications such as abscess formation. Treatment is urgent, complete debridement.

Answer 6

(b) Spermatocoele Epididymal cysts and spermatocoeles are common benign cystic lesions of the epididymis. They can be differentiated by the presence of low level echoes in spermatocoeles, which move on careful examination. Occasionally, spermatocoeles contain crystallised material which can give the initial impression that the lesion is hyperechoic.

Answer 7

(b) Urinary retention is a common complication Prostate biopsy is performed usually via a transrectal route for patients with an elevated (age-specific) PSA, or an abnormal DRE. Complications include haematuria (frequent and usually transient), PR bleeding, infection and retention (uncommon). A negative initial biopsy does not exclude cancer and repeat biopsy (sometimes with extended core protocols) may be required.

Answer 8

(c) Seminoma Seminoma presents in a slightly older age group than the nonseminomatous germ cell tumours. It has the highest rate of association with undescended testis. Lymphoma typically has a more diffuse infiltrative pattern and is the commonest bilateral tumour.

Answer 9

(d) T3b NO MO T1 c cancers are impalpable tumours detected on needle biopsy. T2c tumours are intra-capsular but involve both lobes. T3a cancer.s are extra-capsular without other organ involvement. T3b cancers involve the seminal vesicles. T4 cancers have direct extension into adjacent organs other than the seminal vesicles.

Answer 10

(d) Treatment does not improve sperm quality This is a left sided varicocoele. An obstructing left renal lesion should be excluded. Sperm quality is improved in up to 53% of patients. The commonest approach for embolisation is via the right CFV vein but the RIJ jugular may also be used.

Answer 11

(d) Torsion of the hydatid of morgagni is seen as a photopaenic defect Torsion of the hydatid cannot be identified on scintigraphy as the structure is too small to be accurately defined. An area of increased activity extending from the iliac vessels to the scrotum can sometimes indicate increased perfusion to the scrotum via the pudendal Vessels (nubbin sign).

Answer 12

(a) Hydatid of Morgagni The mullerian duct degenerates at around 6 weeks in the male due to production of mullerian inhibiting factor by Sertoli cells, its remnants form the appendix testis and the utricle.

Answer 13

(a) Prostate carcinoma Other causes include mullerian duct cyst and vas deferens cyst.

Answer 14

(c) lntratesticular tubular ectasia Dilatation of the rete testis is due to blockage of the efferent ductules. It is usually bilateral and lies in the region of the mediastinum. Most testicular tumours are of low signal intensity on T2W.

Answer 15

(c) T2 Weighted T2 weighted imaging clearly depicts the distinction between the peripheral zone and the remainder of the gland. Tumours are seen as foci of low signal on T2. Haemorrhage from recent biopsy can cause confusion. Fat suppression and intravenous gadolinium is not necessary

Answer 16

(b) Epidermoid The classic US 'onion-skin' appearance of an epidermoid cyst of the testis is described. These are benign teratomas containing ectodermal components. The alternating hypo/ hyperechoic layers are due to compact keratin layers contrasted with loosely arranged desquamated squamous cells.

Answer 17

4. e. Malignancy in an undescended testis Lipoma of the cord will have a high signal on both T1-weighted and T2-weighted images. Neurofibroma will demonstrate a target sign on T2-weighted images and is of low attenuation on CT. Abscess will be clinically apparent, hypoechoic on ultrasound and have high signal on T2-weighted images. Haematomas are usually of higher attenuation on CT with varying appearances on MR, but do not demonstrate contrast enhancement.

Answer 18

5. c. Corpus spongiosum enhances more rapidly following gadolinium as compared to the corpora cavernosa Both corpus spongiosum and the corpora have a low signal on T1-weighted images and high signal on T2- weighted images. The periurethral tissue is low signal on T2-weighted images. MR cannot reliably differentiate between Buck’s fascia and tunica albuginea. They are depicted as a single, thick, low-signal rim. A surface coil is used for local disease staging.

Answer 19

6. e. Post-contrast, the peripheral zone enhances more than the central zone The zonal anatomy is best depicted on T2-weighted images. The proximal urethra is not routinely identifiable, unless the patient is catheterised or has had previous TURP. Seminal vesicles are bright on T2-weighted images; the low-intensity structures indicate the neurovascular bundles. The peripheral zone has a higher signal on T2- weighted images and enhances more.

Answer 20

17. b. Bladder and rectal involvement are best seen on coronal images Bladder and rectal involvement are best appreciated on axial and coronal images. MR is much more accurate for prostatic volume assessment and CT usually overestimates prostatic volume

Answer 21

30. c. The majority of extratesticular tumours are benign The epididymis is iso- or hyperechoic compared to the testis. Seminomas are homogenous masses and hypoechoic to the testis. Epidermoid cysts are the commonest intratesticular benign neoplasm. Lipomas are the commonest benign tumours in the spermatic cord.

Answer 22

41. a. The left testis is more susceptible to blunt trauma The testis suffers blunt trauma against the thigh or the symphysis pubis and the right testis, being higher, is more susceptible. Intratesticular haematomas should be followed up to resolution to rule out an underlying neoplasm and also rule out any ensuing complications such as abscess formation which may necessitate orchidectomy

Answer 23

42. a. Lymphoma This is the wrong age group for Leydig cell tumour (childhood) and seminoma (around 40 years). Lymphoma is the commonest tumour in this age group. It is more likely to have a diffuse hypoechoic appearance and be bilateral as compared to metastasis, which usually presents with multiple focal lesions. Tuberculosis of the testis is most often secondary to epididymitis

Answer 24

53. c. Testicular hyperaemia does not exclude torsion An enlarged, diffusely hypoechoic avascular testis with an associated twisted cord is diagnostic of testicular torsion. The testicular echogenicity can be normal in the very early phase of torsion. A detorted testis often demonstrates hyperaemia. Scrotal skin oedema and hydrocoele can also be features of torsion.

Answer 25

D Testicular seminoma The clinical history and ultrasound appearances are highly suggestive of testicular seminoma.

Answer 26

D Testicular epidermoid cyst

Answer 27

B A normal echogenicity testis on grey-scale imaging The section on testicular torsion within the comprehensive review by Fiitterer et al provides useful additional information

Answer 28

E Well-defined, patchy areas of decreased echogenicity within the right In the early phase of acute orchitis, there is oedema of the testis leading to swelling and diffuse low reflectivity on ultrasound. The ultrasound appearances then evolve to increasingly well-defined areas of patchy low reflectivity. Colour Doppler flow is typically increased within these areas of low reflectivity.

Answer 29

A A testicular mass that contains areas of calcification

Answer 30

A The prostatic capsule is breached with seminal vesicle invasion. Stage T3 implies tumour extension through the prostate capsule with/without invasion of the seminal vesicles.

Answer 31

D Pneumoperitoneum Almost all patients complain of pain/discomfort afterwards and up to 80% will experience either haematuria or haematospermia. Perirectal bleeding (up to 37%), infection, vasovagal attack, urinary retention and epididymitis are other recognised complications. Pneumoperitoneum should not occur because the prostate lies well below the peritoneal reflection

Answer 32

B Peripheral zone Seventy per cent of prostate cancers arise from the peripheral zone.

Answer 33

C Mullerian duct cyst This is the typical description of a Mullerian duct cyst. A seminal vesicle cyst is an important differential; however, they are not usually seen in the midline.

Answer 34

D The peripheral zone is of higher signal intensity than the central zone on T2w images.

Answer 35

B The central zone atrophies with advancing age. The central zone atrophies with age whilst the transitional zone enlarges by developing benign prostatic hypertrophy (BPH).

Answer 36

B Prostatic abscess Prostatic abscess is a localised process which usually begins in the peripheral zone of the gland but may spread to other areas. The incidence is increased in diabetic or immunocompromised patients.

Answer 37

E The transitional zone is enlarged The central zone atrophies with age while the transitional zone increases in size as it develops BPH. Peripheral zone enlargement is not a feature of BPH.

Answer 38

D The prostate is identified 2—3 cm above the symphysis pubis. On CT, as a general rule, the prostate is not considered to be enlarged if an image obtained 1 cm above the symphysis does not include the prostate. Unequivocal enlargement of the prostate is diagnosed if the prostate is seen in images 2—3 cm or more above the symphysis pubis.

Answer 39

9. A. Lymphoma. Clinically testicular lymphoma is distinct from other testicular neoplasms in that it occurs in a much older age group. It is the most common testicular neoplasm over the age of 60 years. It is also the most common bilateral testicular neoplasm (up to 38% of cases). The epididymis and spermatic cord are commonly involved. The sonographic appearance is variable and indistinguishable from germ cell tumours. Typically they are discrete hypoechoic lesions that may completely infi ltrate the testicle. Primary leukaemia of the testis is rare, although it is a common site of leukaemia recurrence in children. The sonographic appearances are very variable, as the tumour may be unilateral or bilateral, focal or diffuse, hypoechoic or hyperechoic. Testicular metastases, other than those from lymphoma or leukaemia, are very rare. Primary sites reported include prostate and lung. They are generally seen in the setting of widespread disease and are rarely the presenting complaint. Seminoma is the most common germ cell tumour. The average age of presentation is approximately 40 years. It is typically uniformly hypoechoic on ultrasound and they are only rarely bilateral (2%). Granulomatous orchitis may manifest as a testicular mass, but this would be very unusual. Typically this process tends to involve the epididymis fi rst and to a much greater degree than the testis. Pathogens include TB, syphilis, fungi, and parasites.

Answer 40

23. D. Tubular ectasia of the rete testis. This is also known as cystic transformation of the rete testis and results from partial or complete obliteration of the efferent tubules, which causes ectasia and eventually cystic transformation. It is frequently bilateral, but may be asymmetric. The site is in or adjacent to the mediastinum testis and there are often associated epididymal cysts or spermatoceles. The key to the correct identifi cation of this abnormality is the elongated shape that replaces the mediastinum. Intratesticular varicoceles can occur, but they are very rare. It would be even rarer for it to be thrombosed. Testicular abscess would not usually be multicystic, but would be more rounded with an irregular wall and low-level internal echoes. Testicular infarction usually manifests as a hypoechoic mass that is largely avascular. It is not usually cystic. Epidermoid cyst is a rare benign tumour of germ cell origin. It is usually rounded or oval in shape and classically has a target or ‘onion skin’ appearance of alternating layers of hyper- and hypo-echogenicity. The outer wall is typically hyperechoic and sometimes calcifi ed.

Answer 41

39. A. Repeat scan in 4 weeks. There are a number of important points in this question. Firstly, the date from biopsy must be known to avoid misinterpreting haemorrhage as disease on MRI. Fortunately, the urologists have provided you with the salient information necessary to estimate disease stage from the Partin’s tables. Whilst these are clinical features, they are essential to know when interpreting MRI. The features described indicate a <1% risk of this patient having extracapsular disease. In combination with the unknown date of the biopsy, it would be prudent to exclude the possibility that this low signal in the seminal vesicles is not haemorrhage by repeating the scan. If does represent disease invasion of the seminal vesicles, it would indicate T3b disease.

Answer 42

45. E. All of them. MRI is not a primary investigation in the diagnosis of prostate cancer but it is used in staging known disease. Occasionally, in a patient with a high risk of prostate carcinoma, as in this case, when the urologists have repeatedly failed biopsies, MRI can be used to help guide biopsy. In this setting MRS can also be used to increase confi dence in the diagnosis. As with all prostate imaging for cancer, the results are more reliable in the peripheral zone due to the variability of appearances in the transitional zone. Choline is elevated in prostate cancer, and is thought to reflect increased cell membrane turnover. Creatine, also detected on MRS, is unchanged. Polyamine is reduced. Citrate, which is stored in normal prostatic cells, is reduced, presumably because of reduced normal function within cancerous cells. The (creatine + choline)/citrate ratio has been used to help discriminate prostate cancer from normal prostate. The role of MRS in the transitional zone is unclear.

Answer 43

48. C. Bell clapper deformity predisposes to testicular torsion. Testicular torsion is an emergency. If it is not corrected within 6 hours, testicular salvage is less likely. Torsion results initially in venous obstruction followed by arterial obstruction. The severity of testicular ischemia depends on the duration and the degree of torsion (180-720°). Clinical differentiation between testicular torsion and epididymo-orchitis can be challenging. Two types are described: intravaginal and extravaginal. ‘Bell clapper’ deformity is the term used to describe high attachment of the tunica vaginalis to the spermatic cord that leaves the testis free to rotate. On ultrasound, the affected testis may have normal echogenicity in the early phase. In the later phase, the testis enlarges and demonstrates increased or heterogenous echogenicity. An enlargedand torted spermatic cord may be visualized. Absence of blood flow in the affected testis, with normal flow on the asymptomatic side, is most specific for torsion. Some arterial flow may persist in incomplete torsion (less than 360). Decreased or reversed diastolic flow on pulsedwave Doppler assessment assists in the diagnosis in such cases.

Answer 44

39 Answer A: Extracapsular extensions MRI is used to demonstrate tumour location, extracapsular extension and seminal vesicle invasion. Answer a is T3 a, b is T2b, c is T4, d is T2c, and e is T4

Answer 45

40 Answer D: High signal on T1-weighted images in the peripheral zone Haemorrhage is high signal on T1-weighted images and therefore can be distinguished from tumour

Answer 46

41 Answer A: Testicular germ cell tumour The findings show testicular microlithiasis which is also associated with Klinefelter's syndrome, cryptoorchidism, testicular infarcts, granulomas, infertility, male pseudohermaphroditism, Down's syndrome and alveolar microlithiasis

Answer 47

42 Answer E: Seminoma Seminoma is the most common pure germ cell tumour and average age is 40.50 years

Answer 48

44 Answer E: Lung Metastases to the testis are more common than seminoma in a patient over the age of 50 years. The most common sites (in order of frequency) are prostate, lung, kidney, GI tract, bladder, thyroid, melanoma.

Answer 49

43 Answer C: Epidermoid cyst These are the typical ultrasound appearances of an epidermoid cyst, which is confined to the tunica albuginea.

Answer 50

45 Answer A: Discharge the patient back to GP with no follow-up These findings are consistent with an epididymal cyst, which is incidental to management

Answer 51

46 Answer A: Normal grey-scale appearance of both testes at 12 hours In acute testicular torsion the typical appearances are of decreased blood flow at one hour and absent blood flow after four hours, but remember that torsion-detorsion and incomplete torsion can give false negative appearances. In cryptoorchidism the testes are arrested along their line of development with a l Ox increased risk of torsion. Normal grey-scale appearances of the testes can occur but changes in appearance usually occur after six hours of torsion.

Answer 52

47 Answer C: Staging CT examination Staging CT examination of the chest, abdomen and pelvis is the most appropriate next step following urological referral.

Answer 53

61 Answer B: Torsion of the appendix testis Torsion of the appendix testis and torsion of the appendix epididymis are the most common causes of acute scrotal pain in 6-12 year olds. It is not a real surgical emergency as symptoms usually resolve with supportive care.

Answer 54

42 Answer D: Markedly increased perfusion through spermatic cord vessels with increased activity of scrotal contents on static images Option (a) is seen with testicular abscess. Curvilinear increased activity laterally is seen in epididymitis. Option (c) is seen in acute testicular torsion and (e) in testicular tumour.

Answer 55

45 Answer C: Torsion of the appendix testis The appendix testis is the vestigial remnant of the Mullerian duct and is seen as a small projection from the upper testicular pole in up to 80% of ultrasound examinations. It is common in childhood.

Answer 56

46 Answer C: Scrotal haemangioma Benign paratesticular lesions tend to be well defined, painless and show little or no increase in flow on colour Doppler. Scrotal haemangioma is an exception due to its high vascularity.

Answer 57

47 Answer C: High signal intensity in the prostate bed on axial T2 sequence The usual post-prostatectomy appearance is low signal fibrosis. Increased signal on T2 sequence in the setting of a rising PSA is indicative of local recurrence.

Answer 58

48 Answer D: Mullerian duct cyst This is a remnant of the paramesonephric duct which usually regresses by the third foetal month. It is discovered usually in the third to fourth decade. It tends to be midline and does not communicate with the urethra. It is associated with increased incidence of carcinomatous transformation.

Answer 59

49 Answer D: Unilateral undescended testis post-orchidopexy in a nine month old Testes are normally within the scrotum by 28-32 weeks gestational age. Cryptoorchidism is the arrested descent of testes along their normal course and is associated with an increased risk of testicular cancer (most commonly seminoma). Orchidopexy does not decrease the cancer risk and the risk extends to the contralateral testis.

Answer 60

23 Answer A: Enlarged hyperechoic left testis with increased peritesticular flow and absent parenchymal flow The diagnosis is subacute or missed testicular torsion when symptoms are present for >24 hours and <10 days. The salvage rate is dependent on the time interval between onset of pain and surgery and is 80-100% at <6 hours and near 0% at >24 hours

Answer 61

33 Answer E: Leads to testicular infarction in approximately 3 % of cases The patient has acute epididymo-orchitis. The commonest causative organisms are Chlamydia and N. gonorrhoea in <35 year olds, and E. coli and Proteus mirabilis in >35 year olds. Staphylococcus aureus is also a recognised cause. Testicular torsion is most common in <20 year olds, and acute epididymitis is most common after the age of 20. Prostatic tenderness is infrequent and TB accounts for 2% of cases, while E. coli and S. aureus account for 85%. Testicular infarction is a recognized complication of acute epididymitis from extrinsic compression of testicular blood flow.

Answer 62

36 Answer C: Cavernosal aspiration/irrigation Most cases of priapism are due to veno-occlusive disease with arterial causes being relatively rare and related to trauma. Even with appropriate aspiration & irrigation followed by anticoagulation/shunt surgery, 50% impotence.

Answer 63

38 Answer D: Fournier gangrene Necrotising fasciitis of the scrotum. The prognosis is usually very poor.

Answer 64

39 Answer B: Routine urological referral As the patient is symptomatic the surgeon may discuss surgical options such as marsupialisation. The ultrasound operator needs to be vigilant and thoroughly check the testes for an underlying tumour.

Answer 65

40 Answer A. Time gain compensation Time gain compensation equalises the image brightness between superficial and deeper structures by progressively increasing the gain from deeper (later) echoes. This is adjusted for average tissue attenuation. If a cyst with lower than average attenuation is imaged, the echoes from deeper tissues are over-amplified. Non-linear waveform propagation is the principle behind harmonic imaging, in that the original pulse is distorted so that it comes to contain higher frequency components or harmonics.

Answer 66

42 Answer E: Central enlargement with calcium and mixed echogenicity Size greater than 30 cu cm and peripheral changes are more suspicious of carcinoma. PSA generally increases with age: 3 ng/mL is considered the upper limit of normal up to 60 years, 4 ng/mL to 70 years and 5 ng/mL for those over 70.

Answer 67

59 Answer E: Leydig cell tumour Leydig cell tumours usually present between three and six years of age. They produce oestrogens or testosterones, resulting in gynaecomastia or virilisation.

Answer 68

1. (d) Peripheral zone lesion with low signal on T2 Prostatic carcinoma is best seen as an area of low signal intensity in the peripheral zone of prostate on T2. The normal glandular tissue returns high signal on T2 images

Answer 69

3. (d) Testicular microlithiasis This occurs when there is a defect in the phagocytic activity of Sertoli cells leaving degenerated intratubular debris behind. This condition is usually asymptomatic and ultrasound appearances are typically as described. When testicular microlithiasis is discovered, regular follow up should be performed due to risk of developing a testicular neoplasm.

Answer 70

22. (b) Tubular ectasias of rete testis This is usually seen in older men and is thought to be secondary to cystic dilatation of the rete testis. This is a benign condition and an important differential is teratoma. Ultrasound appearances and MRI features are characteristic. These lesions are isointense (sometimes undetectable) on T2 (unlike teratoma).

Answer 71

29. (b) Fournier’s gangrene Fournier’s gangrene is a progressive necrotising fasciitis in men. Thickening of the scrotal skin and air in the subcutaneous layer are diagnostic.

Answer 72

46. (d) Epidermoid cyst These are the typical radiological appearances of an epidermoid cyst of testis. The ‘onion-ring’ appearance is secondary to alternating layers of compacted keratin and desquamated squamous cells. The water and lipid contents of the cyst result in high signal on both T1 and T2.

Answer 73

48. (b) T2 weighted images These demonstrate the zonal anatomy of the prostate well. The prostatic urethra serves as a reference point. The peripheral zone returns high signal compared with the central or transitional zones.

Answer 74

50. (b) Para-aortic lymph nodes The lymphatics from the testis accompany the veins to the retroperitoneal nodes between the bifurcation and the kidneys. The local inguinal nodes are involved only if there is invasion of the scrotal wall.

Answer 75

Answers: (a) Not correct (b) Correct (c) Correct (d) Not correct. (e) Not correct Explanation: In paediatric patients, intratesticular flow can be difficult to demonstrate on colour Doppler. Power Doppler may be helpful in such cases. When inflamed epididymis is typically enlarged, hypervascular and hypoechoic. Orchitis is seen in 20% cases and shows similar appearance. The normal epididymis is isoechoic to slightly hyperechoic to normal testis.

Answer 76

Answers: (a) Correct (b) Correct (c) Correct (d) Not correct (e) Not correct Explanation: Torsion of testis is rare in neonates. A torted testis is usually hypoechoic on ultrasound due to congestion, infarction and edema.

Answer 77

Answers: (a) Not correct. (b) Not correct (c) Not correct (d) Not correct (e) Correct Explanation: Only cancer located in the peripheral zone can be reliably detected on TRUS, with 60%-70 % appearing hypoechoic, 40% are isoechoic and 1% - 5% are hyperechoic. Intravenous contrast in not used routinely in MRI as it has no superiority of T2WI. T2WI best demonstrates zonal anatomy with cancer appearing as lesion of low signal within the high signal of peripheral zone. All the zones have intermediate signal on T1WI on MRI.

Answer 78

Answers: (a) Correct (b) Not correct (c) Not correct (d) Not correct (e) Correct Explanation: Acoustic shadowing is not seen due to small size of calcification. Infertility is not associated with microlithiasis (association is 1% same as general population). Unilaterality is seen only in 2.7% to 27%.

Answer 79

Answers: (a) Not correct (b) Not correct (c) Correct (d) Correct (e) Not correct Explanation: 1% of intratesticular tumours are epidermoid and most commonly seen between 20-40 yrs. They are usually solitary and unilateral, but cases of multiplicity and bilaterality have been recognized

Answer 80

Answers: (a) Correct (b) Correct (c) Correct (d) Not correct (e) Not correct Explanation: Spontaneous detorsion of testis may occur leading to unilateral testicle hypoperfusion. Surgery is still indicated in these cases. Scintigraphy is highly sensitive and specific when performed only. In the acute phase, there is reduced perfusion in the testis with decreased activity. In the subacute phase, there is a peritesticular reactive hyperaemia with a hilar or increased tracer activity. Later, there is marked absence of tracer activity.

Male reproductive system Flashcards

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