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Breast and Scrotal > Scrotal Powerpoint > Flashcards

Scrotal Powerpoint Flashcards

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1
Q

Scrotum

A

skin pouch, supports the testes outside the body for survival of spermDivided by a septum into 2 compartmentsEach compartment contains a testis, epididymis, spermatic cord and ductus deferens.

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2
Q

Testes

A

2 male reproductive glands, produces sperm and testosteroneSize 3-5 cm in length3cm in height 3x3x5

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3
Q

Seminal vesicles

A

2 sac-like structures located posterior to the bladder, store sperm

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4
Q

Tunica albuginea

A

Dense fibrous capsule surrounding the testes

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5
Q

Tunica vaginales

A

2 serous layers covering the testesA potential space between the 2 layers exists for a hydrocele to form

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6
Q

Septal raphe

A

fibrous tissue dividing the scrotum into 2 separate compartmentsprevents infections on one side from passing to the opposite testicle

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7
Q

Mediastinum testes

A

a vertical septum which provides support for the testicular vessels and ducts to enter and exit

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8
Q

Epididymis

A

elongated structure along the posterolateral aspect of the testisHead,body,tailStores sperm

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9
Q

Appendix testis

A

seen in 80% of patients, a small oval structure on the superior pole, remnant of the mullerian duct

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10
Q

Pampiniform plexus

A

plexus of veins in the spermatic cord that drain into the right and left testicular veins; when a varicocele is present, dilatation and tortuosity may develop

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11
Q

Spermatic cord

A

structure made up of the vas deferens, testicular artery,cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum

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12
Q

SONOGRAPHICALLY TESTE IS

A

SMOOTH, MEDIUM GRAY STRUCTURE WITH FINE ECHOTEXTURE

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13
Q

Normal Rete Testies

A

THE AREA IN THE TESTIS WHERE THE SEMINIFEROUS TUBULES CONVERGE BEFORE DRAINING IN THE HEAD OF THE EPIDIDYMIS

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14
Q

Normal Mediastinum Testis- Transverse Image

A

THE VERTICAL SEPTUM IN THE TESTIS FORMED BY THE MULTIPLE FOLDS OF DENSE, FIBROUS TISSUE THAT COMPLETELY COVERS THE TESTE KNOWN AS THE TUNICA ALBUGINEA

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15
Q

Normal Mediastinum Testis- Sagital Image

A

HELPS TO SUPPORT THE VESSELS & DUCTS THAT COURSE THRU THE TESTESSEEN ON US AS A BRIGHT, HYPERECHOIC LINE

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16
Q

Normal Septal Raphe- Transverse Image

A

THIS FIBROUS TISSUE IS A MIDLINE STRUCTURE THAT CAN BE MISTAKEN BY THE PATIENT AS A NEW “PALPABLE NODULE”

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17
Q

Normal Appendix Testis

A

A SMALL STRUCTURE ATTACHED TO THE UPPER POLE LOCATED BETWEEN THE TESTE AND EPIDIDYMIS90% UNILATERAL OCCURANCE RATENOT TO BE CONFUSED WITH THE EPIDIDYMIS HEADIT IS ISOECHOIC WITH THE TESTE AND IS BEST SEEN WITH A HYDROCELE

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18
Q

Appendix Epididymis

A

IS A SMALL PROTUBANCE FROM THE EPI HEAD WITH ONLY A 34% OCCURANCE RATE

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19
Q

Epididymis location and size

A

beginning superiorly and then coursing posterolater to the testis 6 to 7 cm

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20
Q

Epididymis Head- measurement and location

A

largest part6 to 15 mm in widthsuperior to upper pole of testis

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21
Q

Normal Epididymis Appearence

A

isoechoic or hypoechoic compared with the testis, although the echo texture is coarserSHOULD BE IMAGED ON ALL SCROTAL US EXAMS IN LONG AND TRANS PLANES

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22
Q

Epididymis Head ductules

A

CONTAINS 10-15 DUCTULES COMING FROM THE RETE TESTE TO FORM A SINGLE DUCT IN THE HEAD & BODY OF THE EPIDIDYMIS

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23
Q

BODY OF EPIDIDYMIS

A

COURSES ALONG THE POSTEROLATERAL ASPECT OF THE TESTE-SMALLER THAN THE HEAD AND TAILDIFFUCULT TO IMAGE WHEN NORMAL

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24
Q

Tail of Epididymis

A

POSTERIOR TO THE LOWER POLE OF THE TESTE

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25
Body and Tail of Epididymis
BOTH STRUCTURES CONTAIN A SINGLE DUCT KNOWN AS THE DUCTUS EPIDIDYMIS WHICH BECOMES THE VAS DEFERENS IN THE SPERMATIC CORD
26
Blood Supply- Testicular Arteries
primary blood supply, arise from the abd aorta below the level of the renal arteries
27
Blood Supply- Testicular Arteries Doppler
Normal Doppler signals are low velocity, low resitive flowHelpful in determing torsion or tumor vascularityPower doppler may also be helpful.
28
Arterial Vessels of the Teste
AORTA—TESTICULAR ARTERY—CAPSULAR ARTERY—CENTRIPETAL ARTERY—RECURRENT RAMI
29
50% of men have a
TRANSMEDIASTINAL ARTERY (& ACCOMPANYING VEIN) THAT COURSES THRU THE MEDIASTINUM TOWARDS THE TESTIS CASPSULE
30
COLOR FLOW IN THE TMA WILL BE
OPPOSITE OF THE CENTRIPETAL ARTERIES
31
FLOW IN THE CMA IS _____ FROM THE MEDIASTINUM
away
32
FLOW IN THE CENTRIPETAL ARTERIES IS ______ THE MEDIASTINUM
towards
33
Normal Color demonstrates
BLOOD FLOW IN CENTRIPETAL ARTERIES
34
Spectral Doppler demonstrates
NORMAL LOW-RESISTANCE WAVEFORM
35
Resistive Index
PEAK SYSTOLE MINUS PEAK DIASTOLE DIVIDED BY PEAK SYSTOLE (S-D/S=RI
36
RI values
WILL DIFFER SLIGHTLY DEPENDING ON THE ORGANAVERAGE RANGE IS BETWEEN 0.4-0.8 HIGHER VALUES INDICATE DECREASED PERFUSION
37
ARTERIES WITH LOW-RESISTIVE (LOW IMPEDANCE) BLOOD FLOW SUPPLY
ORGANS THAT NEED CONTINUOUS PERFUSION (LIVER, KIDNEYS, TESTES, UMBILICAL CORD)
38
Testis Benign Pathology- Tubular Ectasia Of the Rete Testes
> age 45
39
Testis Benign Pathology- Intratesticular
located near mediastinum testis
40
Testis Benign Pathology- Abscess
normally from epidiymo-orchitis
41
Testis Benign Pathology- Hydrocele
an abnormal accumulation of serous fluid between the layers of the tunica vaginalisMost common cause of painless scrotal swelling Congenital or acquired (trauma,epididymitis,or torsion)
42
Testis Benign Pathology- Henatoceles
trauma,surgery,torsion,diabetes, or arterosclerosis
43
Testis Benign Pathology- Pyoceles
occurs when an abscess ruptures into an existing hydroceleNormally have septations or scrotal skin thickening
44
Testis Benign Pathology- Varioceles
enlargement of the veins of the spermatic cord most commonly left side< 25 years of age
45
Hydrocele is associated with
neoplasms, tends to be smaller Congenital or idiopathic Usually due to epididymitis
46
Is it normal for a small amount of hydrocele to excist?
Yes
47
Hydrocele is seen with
orchitis, spermatic cord torsion and trauma
48
Hydrocele
collection of serous fluid most common cause of painless scrotal swelling, anechoic with lower frequency or low dynamic range infected has internal echoes
49
PRIMARY VARICOCELES
CAUSE BY AN ABNORMAL DILATION OF THE VEINS OF THE PAMPINIFORM PLEXUS ARE CAUSED BY INCOMPETENT VALVES WITHIN THE SPERMATIC VEIN MORE COMMON ON LEFT DUE TO LSV EMPTING INTO LRV AT A STEEP ANGLE
50
SECONDARY VARICOCELES
MORE COMMON IN MEN OVER 40 AND ARE THE RESULT OF RENAL HYDRO, ABD MASS OR LIVER CIRRHOSIS (as the result of portal hypertension)
51
Infections- Orchitis
inflammation of the testis
52
Infections- Chlamydia
most common cause
53
Infections: Epididymo-Orchitis
infection of epididmyitis and testis most commonly results form the spread of lower urinary tract infection via the spermatic cord abscess can occur
54
EPIDIDYMITIS
Common cause is from the spread of a lower urinary tract infection down the spermatic cord and is the most common cause of acute scrotal pain in adults Pt has increasing pain over several days, fever and often a urethral discharge (from an untreated UTI) Spread to the testis occurs in about 1/3 of the cases
55
EPIDIDYMAL CYSTS
small, anechoic structures filled with serous fluid found anywhere in the epididymis
56
SPERMATOCELE
CYSTIC DILATATIONS OF THE EFFERENT DUCTULES OF THE EPIDIDYMIS ALWAYS LOCATED IN EPIDIDYMAL HEAD FLUID CONTAINS PROTEIN AND SPERMATOZOA MORE COMMON IN VASECTOMY PATIENTS US CANNOT RELIABLY DIFFERENTIATE BETWEEN EPIDIYMAL CYSTS & SPERMATOCELES SPERMATOCELES CAN APPEAR AS SIMPLE CYSTS, WITHOUT DEBRIS & SEPTATIONS
57
Microlithiasis
Small bilateral calcifications < 3mm ( so normally, do not shadow) Associated with cryptorchidism, Klinefelters syndrome (extra x chromosome) infertility, testicular atrophy. Also assocatied with malignancy. Annual sonography is suggested
58
Cryptorchididsm
Undescended testis most common GU anomaly in male infants. Infertility and cancer are 2 potential complications. Undescended testis will be smaller with decreased echogenicity as compared to contralateral normal testis. 80% found in inguinal canal often in preemies higher risk for torsion and cancer
59
Scrotal hernia
Occur when bowel, omentum, or other structures herniate into the scrotum Bowel is most commonly herniated structure, followed by omentum Peristalsis of bowel seen with real time Usually a clinical diagnosis Omentum will be echogenic due to fat
60
Trauma
``` Rapid assessment Marked scrotal pain, swelling Vascular disruption Fracture/rupture Surgical emergency If surgery performed within 72 hours after injury, up to 90% of testes can be saved Only 45% can be saved after 72 hours ```
61
FRACTURED TESTIS
OCCURS FROM DIRECT BLOW TO TESTIS (MVA/ATHLETIC INJURY) 90% CAN BE SAVED IF SURGICAL TREATMENT OCCURS BEFORE 72 HOUR BLOOD FLOW WOULD BE ABSENT IN AREA OF IRREGULAR TESTIS PARENCHYMA NOTE THE SIMILAR APPEARANCE OF FRACTURED AREA TO TESTIS WITH LATE STATE TORSION
62
EARLY TORSION
RT TESTIS IS SWOLLEN WITH MILDLY HETEROGENOUS ECHOCTEXTURE-THOUGH TESTICULAR ECHOGENCITY REMAINS SIMILAR TO UNAFFECTED SIDE TORSION OCCURS FROM BELL CLAPPER DEFORMITY (tunica vaginalis completely surrounds the testis, epididymis and distal spermatic cord lacking the bare area along the posterior scrotal wall)
63
LATE TORSION
RT TESTIS IS NOW HYPOECHOIC & SWOLLEN INDICATING TESTICULAR ISCHEMIA (IN TORSION, VENOUS FLOW IS AFFECTED FIRST CAUSING OCCLUDED VEINS, FOLLOWED BY ARTERIAL OBSTRUCTION-ONCE ARTERIAL FLOW CEASES TISSUE NECROSIS OCCURS AND AFFECTED ORGANS BECOME HYPOECHOIC IN APPEARANCE)
64
Torsion
Bare area not present, the tunica vaginalis completely surrounds the testis, epididymis, and distal spermatic cord, allowing them to move and rotate freely within the scrotum Bell Clapper anomaly Surgical emergency, if surg within 5 to 6 hours of the onset of pain 80-100% of testes can be salvaged Between 6-12 hours, 70% after 12 hours, only 20% can be saved Most common cause of acute scrotal pain in adolescents, can occur at any age but peaks at age 14 Severe pain can cause nausea and vomitting Torsion of the appendix epididymis and appendix testes can also occur
65
Malignant masses
Germ cell and non germ cell 95% are germ cell, elevated hCG and AFP Most common seminoma, then embryonal cell tumors and teratocarcinomas Most frequently between 20 and 34 years of age Extratesticular masses usually benign, intratesticular masses usually malignant
66
Seminoma
most common
67
Metastasis
Rare to the testicle Normally occurs late in life and is bilateral with multiple lesions Primary tumor may originate from prostate or kidneys; less common sites include lung, pancreas, bladder, colon, thyroid or melanoma
68
Lymphoma
Malignant lymphoma makes up 1-7% of all testicular tumors
69
Leukemia
Leukemia involvement of the testicle is most often found in children In children with leukemia, 8% have been reported to have testicular involvement

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