scrotum Flashcards
1
Q
tunica vaginalis
A
extension of the peritoneum into the scrotal sac
2
Q
scrotum surrounded by dense fibrous capsule called
A
tunica albuginea
3
Q
mediastinum testes is formed from
A
invaginations of the tunica albuginea called septula
4
Q
the testes has ___________ seminiferous tubules that converge into about ____________ efferent ducts
A
840|20-30
5
Q
efferent ducts form the ____________________
A
rete testis
6
Q
the rete testes carry seminal fluid from the __________________ to the ____________________
A
testicle |epididymus
7
Q
SIZE of testes
A
3.5 x 2.4 x 3 cm
8
Q
weight testes
A
12-19 grams
9
Q
tunica vaginalis has 2 layers
A
visceral |parietal||small amount of fluid between the layers to assist in movement
10
Q
inner layer covering the testes/epididymus/lower spermatic cord
A
tunica vaginalis parietal layer
11
Q
lines walls of scrotal pouch
A
tunica vaginalies parietal layer||- normally small amount of fluid between layers to assist w/ movement
12
Q
thin layer of tissue that is in direct contact w/ testicular tissue
A
tunica albuginea
13
Q
folds of tunica albuginea form sections within testicle caled
A
mediastinum testis (similar to a hilum)
14
Q
a series of channels within the mediastinum
A
rete testis
15
Q
bld vessels and ductules enter/exit testicle at _______
A
mediastinum
16
Q
the ____________layer of the tunica vaginalis covers the tunica albuginea
A
visceral
17
Q
curved structure lying posterior to testicle
A
epididymus
18
Q
epididymus length
A
6-7 cm
19
Q
epididymis head (aka __________ ___________) is formed from the ________ ____________
A
globus major|rete testis
20
Q
epididymis head width
A
10-12 mm
21
Q
tubules converge into _____________ ________________ which forms body and tail
A
ductus epididymis
22
Q
epididymis body and tail width
A
1-2 mm
23
Q
remnant of mullerian duct
A
appendix testis
24
Q
A small ovoid structure called the ______ ______ may be seen near the epididymal head
A
appendix testis
25
holds the vas deferens , cremasteric, deferential, and testicular arteries, pampiniform plexus of veins, lymph nodes, and nerves
spermatic cord
26
_____________________ muscle manipulates position of testicles in scrotum
cremasteric muscle
27
name 3 layers of scrotal wall
1) skin - outermost layer|2) dartos muscle - muscle layer forms scrotal raphe and separates the 2 testicles||3) tunica vaginalis - inner layer
28
originate from AO to supply testicles ||resistance?||RI __________
R and L gonadal arteries ||low res||RI 0.5 - 0.75
29
_________________ artery courses along testicle periphery and produces branches called ________________ arteries
capsular|centripetal
30
course thru parenchyma to deliver O2 bld to tissues
centripetal
31
centripetal arteries are assessed w/ Doppler to assess ______________________ _________________________
testicular perfusion
32
centripetal artery ||resistance
low resistance and high flow volume
33
originates from internal iliac artery
deferential artery
34
what artery feeds the epididymis and vas deferens
deferential artery
35
deferential artery resistance and RI?
high resistance |RI > 0.75
36
originates from external iliac artery
cremasteric artery
37
the cremasteric artery feeds _______________ _____________
peritesticular tissues
38
cremasteric artery resistance and RI
high resistance |RI > 0.75
39
___________________ ______________ is the network of small veins the merge to form the testicular vein
pampiniform plexus
40
right testicular vein drains into the ____________________
IVC
41
left testicular vein drains into the ___________
left renal vein
42
exocrine fxn __________________|endocrine fxn _______________
sperm production|testosterone secretion
43
sperm maturation occurs in
epididymis
44
sperm and seminal vesicle fluid in the
ejaculatory duct
45
drainage channel for semen, sperm, and urine
urethra
46
secretes alkaline component of semen and nutrients for sperm
seminal vesicle
47
secretes alkaline fluid into semen
prostate
48
secretes mucous for lubrication
Cowper's gland
49
exam indications for scrotal
palpable mass (#1)|pain|swelling|hydrocele|trauma|torsion|neoplasm
50
probe scrotal
7-12 MHZ linear
51
exam objectives scrotal
mass location and echogenicity|extra v intra pathology|trauma|localization of undescended testis|detection varicocele |testicular ischemia|f/u
52
normal echo of scrotum
homogenous|uniform|medium level echoes
53
seen as echogenic linear band w/in testicle
mediastinum testis
54
_____________ _______________ not normally seen
tunica albuginea
55
doppler waveforms of testicle
high antegrade monophasic flow
56
testicular flow resistance
low
57
epididymis echo?
isoechoic or slightly hyperechoic to testicle
58
head best evaluated?
long seen sup to upper pole testes
59
body and tail seen
post and inf to head
60
normal variants
epi cysts (<4 mm)|epi calcifications|small hydrocele|test cyst (2-3 mm)|testicular band|bilobed testicle|polyorchidism
61
3 or more testicles
polyorchidism
62
testes normally descend into scotal sac
26-34 wks GA
63
most undescended test located at
inguinal canal||CT or MRI used to see if in abdomen
64
common complications of crypotorchidism
infertility and cancer||undescnded test usually removed due to risk of cancer
65
surgery to correct cryptorchidism
orchiopexy
66
SA cryptochidism
absent testicle in sac||hypoechoic homogenous well circumscribed teste in ipsilateral inguinal canal almond shaped
67
Cysts
1) tunica albuginea|2) tunica vaginalis|3) intratesticular
68
cysts in tunica albuginea are usually ___________ and _____________
solitary and unilocular
69
SA tunica albuginea cyst
well defined margins|thru transmission and enhancement
70
tunica vaginalis cyst
rare|single or multiple|septations or hemorrhage||dif to differ from tun vag cyst
71
intratesticular cyst
simple|< 2 cm|originate in rete testis||SA|well defined smooth walls|anechoic|thr trans and post enhance
72
tubular ectasia of rete testis
benign multiple tiny cystic tubules located within or adjacent to the mediastinum testis||bilateral|seen w/ spermatocele
73
tubular ectasia of rete testis ass w/
epididymal inflammation or trauma
74
cystic dysplasia of testis
rare congenital malformation||multiple cysts of dif sizes w/ septations
75
cystic dysplasia begins at
mediastinum testis and extends into parenchyma
76
cystic dysplasia is frequently seen w/
renal agenesis or dysplasia
77
epidermoid cyst
benign teratoma tumor of germ cell origin||walls fibrous and may calcify
78
epidermoid cyst sign
onion or target - alternating rings hyper and hypo tissue||have thick keratin
79
epidermoid cyst SA
well circumscribed hypo mass|beneath tunica albuginea |solid|thickened / calcified wall|onion|avascular|bow tie central echogenic
80
simple epi cyst caused by
dilation of epi tubules
81
simple epi cyst can be found
head body tail
82
simple epi cyst contains
serous fluid
83
simple epi cyst SA
anechoic|well circumscribed|can be multiple
84
most common scrotal mass
spermatocele (epididymal cyst)
85
spermatocele caused by
cystic dilatation of epi tubules
86
spermatocele found in
only head of epi
87
spermatocele contains
spermatozoa and sediment
88
spermatocele commonly seen in
post vasectomy
89
spermatocle SA
anechoic|well circumscribed|similar to simple cyst but low level echoes
90
scattered calcifications seen w/
tuberculosis|filariasis|previous trauma
91
course calcifications seen w/
sertoli cell tumors|burned out germ cell tumors
92
microlithiasis seen w/
germ cell tumors|cryptorchidism|trisomy 21 and Klinefelter|previous radiotherapy
93
Extrascrotal Calcifications aka
scrotal pearls||arise between 2 layers of vaginalis|may be loose w/in scrotal sac
94
extratesticular calcifications SA
echogenic foci w/ post shadow outside of testicle but in sac||mobile||twinkle
95
postvasectomy changes
epi enlargement|tubular ectasia of epi|spermatocele and cysts|dilated vas deferens
96
2 MC causes of acute scrotal pain
testicular torsion|acute epididymitis
97
most common cause acute scrotal pain in poster puberty men
acute epididymitus
98
acute epididymitus MC results from ||___________ in males 14-35|____________ _______ in males over 35
STI|lower UTI
99
acute epididymitis symptoms
acute onset pain||fever, dysuria, pyuria, urethral discharge
100
SA acute epididymitis associated w/
enlarged hypo epi|hypo testicle|hyperemia|hydrocele|scrotal wall thickening
101
infection may spread into testicle causing
orchitis
102
orchitis presents as
hypoechoic enlarged testicle w/ hyperemia
103
SA acute epididymitis
thickened tail ----- then entire gland|head > 17 mm|decreased echo|hetero|hydrocele|hypervascular
104
head of epi measures ______ mm w/ acute epididymitis
> 17
105
bacterial orchitis MC caused by
STI
106
viral orchitis MC caused by
mumps
107
Prehn sign
differentiates epididymo-orchitis from torsion||lifting scrotum above symphysis pubis will relieve pain|no relief if torsion
108
acute orchitis SA
focal or diffuse|decreased echogenicity|hypervascular where infected|decreased resistance|RI < 0.5 affected teste|diastolic flow reversal in epi-orch (venous infarction)
109
a complication from epididymitis/orchitis
abscess
110
other causes of abscess
mumps, smallpox, appendicitis
111
SA abscess
mixed echo mass w/ fluid components||no color centrally w/ increased peripheral vascularity
112
describe SA tuberculosis
hetero epi|nodule formation epi|little vascularity in and around nodules
113
___________ ______________ usually seen in diabetic patients
fournier gangrene
114
infection caused by acute necrotizing fasciitis of the perineum, scrotum, and anterior abdominal wall
fournier gangrene
115
complication of fournier gangrene
pneumoscrotum - air in scrotum due to bacterial infection
116
accumulation serous fluid between two layers of tunica vaginalis
hydrocele
117
most common cause of painless swelling
hydrocele
118
describe primary hydrocele
usually seen in pediatric patients caused by persistent communication between the scrotal sac and peritoneum
119
secondary or acquired hydrocele
present after 40 yrs|caused by trauma, torsion, tumors, or inflammation
120
describe SA hydrocele
anechoic fluid collection|thru trans and post enhance|echogenic fibrin or cholesterol seen floating
121
bld collection in scrotal sac
hematocele
122
a hematocele is caused by
trauma, torsion, surgery, diabetes, neoplasms
123
SA hematocele
low level echoes and visible fluid|may have septations||NO increased vascularity around mass
124
collection of pus in scrotal sac
pyocele
125
a pyocele is caused by
rupture of abscess
126
SA pyocele
similar to hematocele|collection fluid, debris, septations||thickened scrotal skin
127
what is the most common malignancy in men 15-35 ?
scrotal neoplasm||90-95 % malignant||seminoma 40-50 %|embryonal cell 20-25%|teratoma 5-10 %|choriocarcinoma 1-3 %
128
most intratesticular masses are _______________|most extratesticular masses are ___________________
malignant|benign
129
most common "pure" germ cell tumor of testes
seminoma (seminomatous tumor)
130
seminomas comprise what % of all germ cell tumors
40-50 %
131
seminomas occur in males age
30-50
132
seminomas are most common in
white males
133
lab values for seminoma
AFP normal||elevated beta HCG||non - sem tumors cause elevated AFP &/or beta HCG
134
there is a significant increased risk of seminoma formation w/ __________________________
cryptorchidism
135
risk factors for seminoma include
cryptorchiidism |fam hx testicular cancer|infertility|Klinefelter|Down Syndrome|smoking|white race
136
Seminomas spread mainly to _____
retroperitoneal nodes||eval para AO lymph nodes
137
____________ __________________ have best prognosis out of all germ cell tumors
pure seminomas - very responsive to radiaiton and chemo
138
SA seminoma
solid round or oval|uniform low level echoes WOUT calcification|hypo|> 1.6 cm show hypervascularity
139
non - seminomatous germ cell tumor
1) mixed malignant germ cell|2) embryonal cell carcinoma|3) yolk sac tumor|4) teratoma|5) choriocarcinoma
140
are seminomatous or non-seminomatous germ cell tumors more aggressive?
non-seminomatous||- cause visceral mets|- requires orchiectomy|- unresponsive to chemo
141
what is the most aggressive testicular malignancy
embryonal cell carcinoma
142
embryonal cell carcinoma occurs in men ages
25-35
143
embryonal cell carcinoma most aggressively invades the
tunica albuginea
144
labs embryonal cell carcinoma
AFP and beta HCG elevated
145
embryonal cell carcinoma SA
more hetero than seminoma||solid and cystic portions||coarse calcifications||distortion organ contour
146
contains 2 or more types of germ cell tumor tissue
mixed germ cell tumors
147
what is the most common non-seminomatous germ cell tumor
mixed germ cell tumor
148
second most common primary malignancy of testicles
mixed germ cell tumor
149
mixed germ cell tumors occur in men ages
20- 30 ||rarely occur before puberty or after 50
150
most common combo of mixed germ cell tumor
embyronal cell carcinoma |teratoma
151
SA mixed germ cell tumor
varies w/ combo
152
most common testicular tumor in patients |< 2 yrs old
yolk sac tumor
153
labs yolk sac tumor
elevated AFP||normal beta HCG
154
SA yolk sac tumor
cystic areas and echo foci from hemorrhage and necrosis
155
2nd most common testicular tumor in infants and young children
teratomas
156
are teratomas benign or malignant
usually benign||if found in adult usually malignant
157
teratomas contain what
bone, cartilage, smooth muslce and other tissues
158
labs teratoma
elevated AFP and beta HCG
159
SA teratoma
large hetero complex mass|calcifications and cystic areas
160
rarest germ cell tumor
choriocarcinoma
161
choriocarcinoma occurs in men ages
20-30
162
labs choriocarcinoma
elevated beta HCG (can cause gynecomastia)||normal AFP
163
stromal cell tumors (non - germ cell tumors)
leydig cell|sertoli|granulosa|mixed
164
leydig cell tumors
> 85 % benign|5-10 yrs old or 30-60 yrs old||painless palpable mass|normal beta and AFP||cause endocrine imbalance w/ estrogen and testosterone
165
SA leydig cell
small solid homogenous|irregular borders|hypoechoic|increased peripheral vascularity|hemorrage
166
sertoli cell tumors
rare - malig or benign|painless mass|may calcify|endocrine imbalance|bilateral and multifocal
167
gonadal stromal cell tumors combined with germ cell tumors
gonadoblastoma||occur w/ cryptorchidism and hypospadias
168
sex cord cells
germ cell stromal||mixed germ and stromal cell tumors
169
testicular metastasis most commonly comes from
prostate and lung ||usually multiple tumors seen||more common than germ cell tumors in patients > 50
170
most common bilateral testicular tumor
lymphoma
171
most common secondary malignancy of testes
lymphoma
172
most patients diagnosed w/ lymphoma age
60-70
173
lymphoma
extension into cord and epi common||can be focal or diffuse
174
SA lymphoma
homo and hypo to surrounding tissue|increased vascularity
175
2nd most common metastatic neoplasm
leukemia||can be focal or diffuse|unilateral or bilateral
176
SA leukemia
nonspecific|similiar to lymphoma||hypo enlargement of testes|hypervascularity
177
rare tumors
adrenal rests|- ass w/ Cushings and adrenal hyperplasia|- hypo echoic |- wheel spoke||epidermoid cyst|malakoplakia|carcinoid|mesenchymal
178
presents as recurrent epididymitis
sarcoidosis
179
inflammatory disease that can affect several organs
sarcoidosis
180
SA |sarcoidosis
found in testicles or epi|irregular hypo solid mass in testicle \|diffuse w/ multiple hypo nodules|enlarged epi w/ hypo nodule formation
181
most benign extratesticular tumors involve the
epi
182
__________________ can form nodules in the epi|_________________ ____________________ are a common effect of vasectomy|_________________ __________________ most common extratesticular tumor
sarcoidosis|spermatic granulomas||adenomatoid tumor
183
SA adenomatoid tumor
round or ovoid|well circumscribed|hypo or avascular
184
extratesticular malignant neoplasms
fibrosarcoma|liposarcoma|lymphoma|rhabdomyosarcoma|mets to epi is rare
185
collection of abnormal dilated serpiginous veins posterior to testes that extend into spermatic cord
varicocele
186
most common cause of male infertility
varicocele
187
idiopathic varicocele - ||secondary varicocele -
incompetent valves in internal spermatic vein||increased pressure caused by abdominal mass or hydro
188
which side is more common for a varicocele and why?
left||L gonadal vein empties into LRV||SMA may compress LRV causing increased pressure and stasis in venous systems of L kidney and L testicle
189
SA varicocele extratesticular
multiple tortuous anechoic structures prox to upper testes
190
SA varicocele intratesticular
multiple cystic structures w/in rete testes fill w/ color
191
SA varicocele
veins dilate w/ valsalva|>2 mm diameter abnormal supine|>2.5 mm diameter abnormal standing||upper abdomen eval for mass if varicocele found on right|L kidney eval if varicocele found on left
192
loss of blood flow to portion or all of testicle
scrotal infarction||focal or diffuse
193
testicular infarction is related to
torsion|trauma|bacterial endocarditis|leukemia|vasculitis
194
SA infarction
varying echo due to age of infarct||acute- hypo|chronic - hyper/calcifications/reduced testicle size
195
testicle becomes detached from tunica vaginalis allowing it to rotate freely within scrotal sac - may twist
testicular torsion
196
testicular torsion observed in males less than
30 yrs old||typically 12 - 18
197
torsion is typically on what side
left
198
teste salvage rate||< 6 hrs|6-12 hrs|>12 hrs
excellent|declining|poor
199
torsion||<4 hrs|> 4 hrs|> 24 hrs
absent flow in testicle / normal teste||increased teste size/ hetero/ hydrocele/ absent flow||scrotal wall thickening/ areas infarct and necrosis
200
torsion symptoms
acute testicular pain|swollen scrotum|N/V
201
torsion treatment
manual detorsion
202
most common cause of acute scrotal pain in prepubertal boys?
torsion of appendix testes
203
SA torsion
variable echogenicity testis||acute torsion - enlarged testicle, hypo, mottled||areas infarct||thickened scrotal wall and spermatic cord
204
complete torsion SA
absent intratesticular flow
205
partial torsion SA
some high resistance flow w/ absent or reversed diastolic flow||asymmetry of RI
206
epi torsion
hypo enlarged epi w/ variable echo and NO vascularity||normal teste appearance and vascularity
207
torsion appendix testis SA
hypo enlarged mass w/ variable echo and NO vascularity||located tween normal teste and normal epi|normal teste and epi
208
ruptured testicle
critical finding|areas hemorrhage and infarction|hematocele
209
small intestine, colon, and/or omentum falls into scrotal sac thru abnormal opening in inguinal canal
scrotal hernia
210
scrotal hernia SA
echogenic material in scrotal sac|dirty shadowing|valsalva shows peristalsis herniated contents|color w/ valsalva
211
extravasation of spermatozoa into tissues around epididymis
sperm granulomas
212
SA sperm granulomas
solid hypo or hetero mass|may have calcifications
213
fluid accumulation in tissues of scrotum
scrotal wall thickening
214
inflammatory causes of scrotal wall thickening include
cellulitis and Fournier gangrene
215
risk factors for inflammatory scrotal wall thickening
obesity|diabetes|immunocompromised
216
SA inflammatory scrotal wall thickening
wall thickness > 8mm |hypo areas w/ increased vascularity
217
non-inflammatory causes scrotal wall thickening
CHF|lymphedema|liver failure|lymphatic/venous obstruction
218
SA non-inflammatory scrotal wall thickening
wall thickness > 8mm|layers alternating hypo and hyper|normal vascularity
