Scrotal Patho Flashcards Preview

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Flashcards in Scrotal Patho Deck (109):
1

Why can scrotal traumas be difficult to scan?

scrotum is often painful and swollen

2

What causes scrotal trauma?

-MVA
-athletic injury
-direct blow
-straddle injury

3

Goal for sonographer:

see if rupture of scrotum has occurred.

4

How much of the testes can be saved if surgery on ruptured testicle performed within 72 hours?

90%

5

What percent of ruptured testicles can be saved if surgery is performed after 72 hours?

45%

6

Son findings of scrotal rupture

-focal alteration of the testicular parenchymal pattern
-interruption of the tunica albuginea
-irregular scrotal contour
-scrotal wall thickening
-hematocele

7

What is a scrotal hematocele?

blood located between the visceral and parietal layers of the tunica vaginalis

8

What can scrotal hematocele result from?

bleeding of the pampiniform plexus or other extra testicular structure

9

Son appearance of acute scrotal hematocele:

echogenic with numerous, highly visible echoes that can be seen to float or move in real time

10

Son appearance of older scrotal hematocele:

low level echoes with fluid-fluid levels or septations

11

Son findings of scrotal hematoma:

-may be large, causing displacement of testis
-homogenous areas in scrotum
-become more complex with time, developing cystic components
-avascular
-may involve testis or epididymus or they can be contained in scrotal wall

12

What is epididymo-orchitis?

infection of the epididymus and testis

13

What does epididymo-orchitis result from?

-spread of lower UTI via spermatic cord**
-mumps
-syphillis
-viruses
-trauma
-chemical causes

14

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

epididymo-orchitis

15

What's the term for only infection of the epididymus?

epididymitis..spreads to testis in about 20-40% of cases

16

Orchitis is almost always secondary to _______

epidymitis

17

Clinical symptoms of epididymo-orchitis

-scrotal pain that increases over 1 or 2 days
-fever
-urethral discharge

18

Son findings of epididymo-orchitis

-enlarged hypoechoic epididymus
-focal hyperechoic areas may be seen if hemorrhage has occured
-increased blood flow
-enlarged testis
-may be focal or diffuse (affected areas appearing hypoechoic compared to the surrounding tissue
-scrotal wall thickening
-hydroceles
-pyelocele possible

19

U/S exam for epididymo-orchitis must include:

-image showing both testes so the size and echogenicity can be compared
-image with color box opened wide to show portions of both testes so that the flow between sides can be compared

20

Describe scrotal hydroceles:

-fluid formation between the visceral and parietal layers of tunica vaginalis
-found along anterolateral aspect of testis
-may be anechoic or contain low level echoes
-complex hydroceles can be associated with severe epididymitis and orchitis (may contain thick septations and echoes)

21

Describe pyelocele of the scrotum

-occurs when puss fills the space between layers of the tunica vaginalis
-contains internal septations, debris and loculations

22

Why does torsion occur?

-result of abnormal mobility of the testis within the scrotum
-the testis and epididymis twist within the scrotum, cutting off the vascular supply within the spermatic cord
-blood flow is compromised to the testis, epididymis and the intrascrotal portions of the spermatic cord

23

Describe flow issues with torsion

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

24

T/F: Torsion is not a surgical emergency?

False, it is

25

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

-80-100%

26

What is the salvage rate for torsion if surgery is performed 6-12 hours after pain onset?

70%

27

After 12 hours of pain onset, what is the salvage rate for torsion?

20%

28

What is the most common cause for scrotal pain in adolescents?

torsion, peak age is 14

29

Clinical symptoms of torsion:

-sudden onset of scrotal pain
-swelling of affected side
-nausea
-vomiting

30

Son findings of torsion before 4 hours:

may appear normal

31

Son findings of torsion after 4-6 hours

-testis may become swollen and hypoechoic
-affected side will be avascular
-epididymal head may appear enlarged and may have a decreased echogenicity or heterogeneous texture
-scrotal skin thickening
-reactive hydrocele

32

Son doppler findings of torsion

-makes diagnostic images of torsion duh
-an absence of perfusion in the symptomatic side with normal perfusion demonstrated in the asymptomatic side is considered diagnostic of torsion
-doppler parameters must be adjusted for optimal detection of a slow flow rate

33

Describe scrotal cysts:

-benign fluid collections located within the extra testicular structures
-most are extratesticular and are found in the tunica albuginea or epididymus

34

What are spermatoceles?

-cystic dilatations of the efferent ductules of the epididymis
-always located in the epididymal head

35

What do spermatocele cysts contain?

proteinaceuos fluid and spermatozoa

36

What may be seen more often following a vasectomy?

spermatoceles

37

Son findings of spermatoceles

-may be simple cysts
-may be mulilocular cystic collections
-may contain internal echoes
-

38

What are epididymal cysts?

-small, clear cysts containing serous fluid
-found anywhere in the epididymis
-asymptomatic and benign but may be palpable

39

Son findings of epididymal cysts:

-simple fluid filled structures
-thin walls
-posterior enhancement

40

T/F: U/S cannot reliably differentiate between epididymal cysts and spermatoceles?

True

41

What is a varicocele?

-abnormal dilatation of the veins of the pampinoform plexus (in spermatic cord)

42

What are varicoceles caused by?

incompetent venous valves within the spermatic vein

43

Where are varicoceles more common?

- on the left due to the left spermatic vein emptying into the left renal vein at a steep angle which may inhibit blood flow
--left renal vein may also become compressed between aorta and the SMA

44

T/F: Varicoceles are associated with male infertiity?

True, but treatment can increase sperm count up to 53%

45

Son findings of varicoceles:

-numerous tortuous tubes of varying sizes within the spermatic cord near the epididymal head
-tubes may contain echoes that move
-measure more than 2 mm in diameter
-increase in diameter with valsalva

46

How does one scan for varicoceles?

-pt. in upright position will enhance the visibility of the varicoceles because the veins become distended
-color and spectral doppler should be used to demonstrate the presence of venous flow and to demonstrate retrograde filling with valsalva

47

What is scrotal hernia?

bowel, omentum or other structures herniate into the scrotum

48

Son findings of scrotal hernia?

-peristalsis of bowel seen with real time imaging in the scrotum
-may require cineloop for physician

49

What is tubular ectasia or the rete testis?

-a benign condition associated with the presence of a spermatocele, epididumal or testicular cyst or other epididymal obstruction on the same side

50

Where are the rete testis?

at the hilum of the testis where the mediastinum resides

51

Tubular ectasia is more common over what age?

45

52

Son findings of tubular ectasia of the rete testis:

-the normal rete testis may not be clearly seen with U/S imaging
-appears as prominent hypoechoic channels near the echogenic mediastinum testis
-avascular nature

53

Testicular cysts are more common after what age?

40 years

54

Testicular cysts are associated with

spermatoceles

55

What are testicular cysts located near?

mediastinum, may be single or multiple in various sizes

56

T/F: Testicular cysts are incidental findings and require no follow up?

True

57

Son findings of testicular cysts:

-anechoic
-post. enhancement
-smooth walls

58

Describe microlithiasis:

-uncommon
-tiny calcifications within testes
-smaller than 3 mm
-usually bilateral
-associated with malignancy

59

Another name for microlithiasis

scrotal pearls

60

Son findings of microlithiasis

-multiple bright, nonshadowing foci scattered throughout testis
-may be numerous or few
-not abnormal unless more than 5 seen in one image

61

What is the most common malignancy in men between ages of 15 and 35?

testicular cancer

62

Who is more likely to get testicular cancer?

white men

63

Undescended testicles are how much more likely to develop cancer?

2.5-8 X's

64

Clinical findings of testicular cancer:

-painless bump
-testicular enlargement
-mild discomfort

65

Primary goal of U/S for testicular cancer

determine the mass location and differentiate between cystic and solid composition

66

Extratesticular masses are usually ____ while intratesticular masses are more likely to be_____.

benign, malignant

67

Testicular tumors are classified into:

-germ cell
-non germ cell (usually benign)

68

Germ cell tumors are associated with:

elevated HcG and AFP

69

Approx. ____ % of testicular tumors are germ cell tumors and are highly malignant

95%

70

Types of malignant testicular tumors:

-seminomas (most common)
-mixed embryonal cell tumors
-teratocarcinomas

71

Son findings of seminomas:

-homogenous
-hypoechoic mass
-smooth borders

72

Son findings of embryonal cell carcinoma:

-heterogenous
-not well circumscribed

73

Teratomas are ____ in children but _____ in adults

benign, malignant

74

Son findings of teratomas

-heterogenous with well defined borders
-may contain dense foci with shadowing

75

What is cryptorchidism?

undescended testicle that cannot be brought into the scrotum with external manipulation

76

What causes cryptorchidism?

during fetal growth the testis fail to descend into the scrotum from the retroperitoneum by the kidneys

77

Where may undescended testis be found?

-abdomen, inguinal canal (most common), other ectopic area

78

What may cryptochidism result in?

-infertility
-malignancy
-torsion

79

Describe normal prostate?

-chestnut/oval shaped glandular structure
-retroperitoneal
-surrouded by fibrous capsule
-glandular and fibromuscular tissue
-surrounds prox. urethra

80

Where is the cephalic end (base) of the prostate?

adhered to the base of urinary bladder

81

What are the 3 lumenal structures that traverse te prostate?

Rt. and Lt. ejaculatory ducts and urethra

82

What is the verumontanum?

where the ejaculatory ducts and urethra join (looks like Eiffel tower) in trans.

83

Where is the verumontanum located?

-inferior to bladder
-b/w rectum (posterior) and pubis (anterior)
-seminal vesicles and vas deferens rest cephalad against base of prostate
-seminal ves. post. to bladder, ant. to rectal wall

84

***Where are seminal vesicles and vas deferens related to the prostate?

rest cephalad against base of prostate

85

What attaches the prostate to the symphasis pubis?

prostatic ligaments

86

Seminal vesicles resemble what?

bows, paired

87

****How are prostate zones determined?

based on function of tissue within zones

88

***What are the two types of prostate tissue?

-fibromuscular
-glandular

89

Describe fibromuscular prostate tissue?

mainly smooth muscle, anterior portion of prostate

90

How much of prostate is made up of glandular tissue?

2/3, but <1 zones

91

What are the 4 prostate zones?

-peripheral
-central
-transition
-periurethral

92

Peripheral zone is what percent of glandular tissue?

70%

93

What portions of the gland are peripheral zone?

posterior, lateral, apical

94

What zone is most often involve with cancer and prostatis?

Peripheral zone

95

The central zone makes up what percent of prostate glandular tissue?

-25%

96

What percent of the prostate zones does the transition zone make up?

5%

97

What is a site for BPH (benign prostatic hypertrophy)

transition zone

98

Periurethral zone: is what % of gland?

1% of gland

99

T/F: U/S is currently used as a screening for prostate?

False

100

***Patient complaints that are indications for prostate testing?

-hematospermia
-pain on ejaculation
-dysuria
-perineal pain

101

****What is the most common finding of prostate test?

prostatitis

102

***What is benign prostatic hypertrophy?

enlarge prostate

103

***What are symptoms of benign prostatic hypertrophy?

-frequency
-nocturia
-dribbling
-difficulty starting a stream

104

***What is the sonographic appearance of BPH?

-enlargement of the central gland, more rounded
-may have nodularity-fibro glandular changes

105

***What is the most common cancer in American men?

Prostate cancer

106

***What is the second most common male killer cancer?

Prostate cancer

107

***How may a patient present with prostate cancer?

-bladder outlet obstruction
-abnormal DRE
-bone pain
-weakness
-weight loss
-anemia
-azotemia

108

***3 tests that suggest a need for biopsy:

-DRE
-PSA
-endorectal

109

***Son appearance of prostate cancer:

-hypoechoic nodule in peripheral zone
-calcifications are not usually present
-increased PSA