pathology Flashcards
(130 cards)
1
Q
goal of the exam
A
- evaluate size, echogenicity, and structure of each testis.
- determine whether testicular parenchyma appears uniform with an equal echogenicity between sides
- document masses
2
Q
evaluation of the scrotum
A
- is epididymis normal? is scrotal skin thickened?
- turn on color Doppler to assess flow. is there an absence of flow in testis or is it hyperemic? how does color Doppler compare between sides?
- check flow in each epididymis
3
Q
trauma may be result of
A
- MVA
- athletic injury
- direct blow to scrotum
- straddle injury
4
Q
ultrasound of scrotal trauma presents challenge due to
A
edema and pain
5
Q
if surgery is performed within 72 hours following injury,
A
up to 90% of testes can be saved but only 45% can be saved after 72 hours
6
Q
potential complications of trauma
A
- testicular rupture
- hematocele
- hematoma
- hydrocele
- epididymitis
- orchitis
- torsion
7
Q
determine if rupture is present
A
- focal alteration of testicular parenchymal pattern
- interruption of tunica albuginea
- irregular testicular contour
- scrotal wall thickening hematocele
- blood flow disruption across surface of testis indicates rupture
8
Q
hematocele
A
blood collected within the layers of the tunica vaginalis
9
Q
hematocele sonographic appearance
A
varies with age
10
Q
acute hematocele sonographically is
A
echogenic with numerous highly visible echoes that can be seen to float or move in real time
11
Q
with time hematocele sonographically show
A
low-level echoes and develop fluid-filled levels or septations
12
Q
presence of hematocele does not confirm
A
rupture
13
Q
hematomas may involve
A
testis or epididymis or they can be contained within scrotal wall
14
Q
hematomas appear as
A
heterogenous areas within scrotum which becomes more complex with time, developing cystic components
15
Q
hematoma may be
A
large and cause displacement of the associated testis
16
Q
epididym-orchitis
A
infection of both epididymis and testis
17
Q
epididymitis and/or orchitis may result from
A
trauma
18
Q
epididym-orchitis most commonly results from
A
spread of lower urinary tract infection
19
Q
color Doppler imaging with epididymo-orchitis can be used to identify associated
A
increased vascularity
20
Q
epididym-orchitis most common cause of
A
acute scrotal pain in adults
21
Q
sonographic epididymitis appears
A
enlarged, hypoechoic gland and increase vascularity
22
Q
sonographic findings of epididymo-orchitis with color Doppler
A
hyperemic flow confirmed
23
Q
hyperemic flow with epididymo-orchitis seen in epididymis and testis when both involved but
A
is restricted to epididymis if testis is normal
24
Q
orchitis
A
inflammation in the testis
25
hydrocele
contain serous fluid within the cavity of the tunica vaginalis
26
hydrocele most common cause of
painless scrotal swelling, acute or chronic
27
hydrocele may be
idiopathic but commonly associated with epididymo-orchitis and torsion
28
hydrocele are much more common than
hematoceles and pyoceles
29
pyocele is
a collection of pus
30
pyocele occur with
untreated infection or when an abscess ruptures into space between layers of tunica vaginalis
31
torsion
testis and epididymis twist within scrotum, cutting off vascular supply within spermatic cord
32
torsion comprised blood flow to
testis, epididymis, and intrascrotal portion of spermatic cord
33
torsion first affects
venous flow cause swelling of scrotal structures on affected side
34
if torsion continues
arterial flow obstructed, and testicular ischemia follows
35
torsion within 5 to 6 hours of onset pain
80% to 100% of testes can be salvaged
36
torsion 6-12 hour salvage rate is
70%
37
torsion after 12 hours only
20% will be saved
38
clinical symptoms of torsion
- presents with sudden onset of scrotal pain with swelling on affected side
- severe pain causes nausea and vomiting in many patients
39
torsion can occur at
any age
40
torsion most common in
adolescents/ young adults, peak age 14
41
undescended testes are
10 times more likely than normal testes to be affected by torsion
42
bell clapper deformity occurs when
the gubernaculum ligament absent that tunica vaginalis completely surrounds testis, epididymis, distal spermatic cord, allowing them to move and rotate freely within scrotum
43
gubernaculum ligament
which helps to hold testis in place
44
extratesticular masses
- epididymal (head) cysts
- tunica albuginea cysts
- tunica vaginalis cysts
- varicocele
- scrotal hernia
- sperm granuloma
45
epididymal cysts, tunica albuginea/ vaginalis cysts, and spermatoceles are generally
asymptomatic but often palpable
46
epididymal (head) cyst
are clear cysts containing serous fluid located within the epididymis
47
epididymal cyst typically
small but can grow large
48
epididymal cyst occur most often
in the epididymal head
49
spermatocele
is a large cyst at the epididymis head
50
varicocele
abnormal dilation of veins of pampiniform plexus and/ or of peritesticular veins
51
varicocele most common cause of
male infertility
52
varicocele most common on
left
53
varicocele is seen
40% of left testicular and 23% of right
54
varicocele could be
primary or secondary
55
primary varicoceles usually caused by
incompetent venous valves within scrotal veins
56
secondary varicoceles are caused by
increased pressure on testicular vein
57
varicocele may be result of
renal hydronephrosis, abdominal mass, or liver cirrhosis
58
varicocele sonographic appearance
- numerous tortuous tubes of varying sizes within spermatic cord near epididymal head or adjacent to testis
- >2cm A-P
- tubes may contain echoes that move with real-time imaging
- increased flow upon Valsalva maneuver
59
scrotal hernia occurs when
bowel or omentum herniate into scrotum
60
scrotal hernia clinical diagnosis usually
sufficient, sonography helpful in cases of equivocal findings
61
most herniated structure
bowel followed by omentum
62
peristalsis of bowel seen with
real-time imaging, confirms the diagnosis of a scrotal hernia
63
inguinal hernia is confined to
the inguinal canal
64
sperm granulomas occur as
focal chronic inflammatory reactions to extravasation of spermatozoa
65
sperm granuloma most frequently seen in
patients with history of vasectomy
66
sperm granuloma may be located
anywhere within epidiymis or vas deferens
67
benign testicular masses
- tubular ectasia of the rete testis
- cyst
- epidermoid cyst
- microlithiasis
68
tubular ectasia of the rete testis
dilation of rete testis, uncommon, benign
69
tubular ectasia of the rete testis associated with
presence of a spermatocele, epididymal or testicular cyst or other epididymal obstruction on same side as the dilated tubules
70
testicular cyst more common in men
over 40
71
testicular cyst associated with
extratesticular spermatoceles (epididymal cysts)
72
testicular cyst located
near mediastinum
73
testicular cyst can be
single or multiple and of varying size
74
epidermoid cyst
composed of keratin
75
epidermoid cyst presentation can be like
that of a malignant tumors
76
epidermoid cyst sonographic appearance
- variable
- may demonstrate an onion skin or target appearance
- no color flow
77
microlithiasis
multiple calcifications
78
microlithiasis measure
< 3mm
79
microlithiasis are usually
bilateral
80
microlithiasis reported to have association with
testicular malignancy, exact nature unknown
81
microlithiasis associated with
- cryptorchidism
- Klinefelter's syndrome
- infertility
- varicoceles
- testicular atrophy
- male pseudohermaphroditism
82
extratesticular masses usually
benign
83
intratesticular masses more likely to be
malignant
84
testicular masses are categorized as either
germ cell (malignant) or non-germ cell (usually benign)
85
germ cell tumors elevated
HCG and AFP
86
germ cells approximately
95% of all testicular tumors are of germ cell type
87
most common type of germ call tumors is
- seminoma
- followed by mixed embroyonal cell tumors and teratocarcinomas
88
non-germ cells tumors are generally
benign
89
non-germ cell tumors sonographically
tumors appear as focal, hypervascular, hypechoic, or heterogenous masses
90
testicular cancer is
rare (1% of male cancers)
91
testicular cancers usually occur
in males between the ages of 20-34
92
testicular cancer is one of the most
curable types of cancer
93
testicular cancer symptoms
- painless lump
- testicular enlargement
- vague discomfort in scrotum
94
seminoma is
germ cell tumor
95
seminoma most common primary
testicular tumor
96
seminomas tend to be
homogenous, hypoechoic masses with a smooth border
97
seminoma do not often contain
calcification or cystic components
98
embryonal cell carcinoma is
more aggressive than seminomas
99
embryonal cell sonography
- heterogenous
- calcifications present
100
germ cell tumors
- seminoma
- embryonal cell carcinoma
- leydig cell tumors
- teratocarcinomas
- choriocarcinoma
101
leydig cells make
testosterone
102
leydig cell tumors are
rare, making up less then 5% of testis cancer
103
leydig cell tumors have an
excellent prognosis if surgically resected
104
teratocarcinomas form of
malignant teratoma occurring especially in the testis
105
teratocarcinomas made of
different tissues such as hair, muscle or bone
106
choriocarcinoma
has varied sonographic appearances because of mixed cell types
107
metastasis to testicle
is rare, normally occurring later in life
108
with metastasis primary tumor may originate from
prostate or kidneys
109
with metastasis less common sites
- lung
- pancreas
- bladder
- colon
- thyroid
- melanoma
110
sonographic findings of metastasis
- solid hypo or hyperechoic mass
- mixture of both
111
lymphoma most common
bilateral secondary testicular neoplasm affecting men >60 years
112
leukemia next common
secondary testicular neoplasm, most often found in children
113
cryptorchidism
undecended testis(es)
114
cryptorchidism may be located in
- abdomen
- inguinal canal
- other ectopic location
115
cryptorchidism associated with
infertility and increased risk of cancer
116
cryptorchidism sonographic findings
- smaller and less echogenic than normal testis
- mediastinum rarely seen
117
cryptorchidism is
bilateral 10% to 25% of cases
118
testicular ectopia
very rare condition
119
ectopic testicle cannot be
manipulated into correct path of descent
120
testicular ectopia most commonly
in inguinal canal
121
testicular ectopia other sites include
- perineum
- femoral canal
- suprapubic area
- penis
- diaphragm
- other hemiscrotum
122
anorchia
rare condition
123
unilateral anorchia or monorchidism found
in 4% of patients with nonpalpable testis
124
anorchia most common on
left side
125
anorchia caused by
intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero
126
polyorchidism
very rare disorder
127
polyorchidism more common on
left side
128
polyorchidism usually found in
scrotum, has also been found in inguinal canal or retroperitoneum
129
polyorchidism increased risk of
- malignancy
- cryptorchidism
- inguinal hernia
- torsion
130
polyorchidism duplicated
testis, usually small, efferent spermatic system completely absent
