Scrotum Flashcards
0
Q
what are the parts of the scrotum
A
testes, epididymis, and spermatic cord
1
Q
what is the scrotum
A
supporting structure for the testes that allows for sperm survival
2
Q
the testicles form part of the male reproductive organs, with a primary function of producing ______ and the male hormone ______
A
sperm
testosterone
3
Q
US imaging is the modality of choice for scrotum…what is used during the exam
A
high frequency
doppler
improved spatial and contrast resolution
color doppler adds increased sensitivity to display scrotal perfusion
4
Q
describe the testes
A
resides in scrotum symmetric oval gland exocrine gland - spermatozoa endocrine gland - testosterone
5
Q
normal testes measurement
A
3-5 cm length x 3 cm AP x 2-4 cm wide
6
Q
conical lobules contain _________ tubules
A
seminiferous
7
Q
scrotum is divided by the _____ _____
A
median raphe
8
Q
tubules converge to form the network of channels…
______ drains into the head of the epididymis in the ______ where the mediastinum resides
A
rete testis
hilum
9
Q
sperm cells are formed in which 6 locations
A
seminiferous tubules tubuli recti rete testis efferent ductules ductus epididymis vas deferens
10
Q
describe the epididymis
A
6-7 cm
tubular structure
posterior and superior
head, body, tail
11
Q
describe epididymis head
A
superior to the upper pole
6-15 mm
12
Q
what is the job of the epididymis
A
store and transport sperm (through head, body, tail)
13
Q
describe ductus epididymis
A
single duct in body and tail
14
Q
describe vas deferens
A
continues in spermatic cord
transports sperm to the seminal vesicles
15
Q
what are seminal vesicles
A
contains fluid for sperm
16
Q
ductus (vas) deferens is surgically interrupted during a ________
A
vasectomy
17
Q
the ________ or ________ gland secretes fluid
A
bulbourethral or cowper
18
Q
describe appendix testis
A
remnant of the mullerian duct - ovoid structure beneath the head of the epididymis
19
Q
know part of the testis on slide 18
A
study it !!
20
Q
describe the tunica albuginea
A
dense, fibrous tissue, completely covers testes
21
Q
describe mediastinum testis
A
posterior aspect of multiple septation reflects into testis
linear stripe of variable thickness running through the testis in a craniocaudal direction
22
Q
describe the tunica vaginalis
A
serous covering of testis which is a double layer extension of peritoneum
23
Q
where do hydroceles form
important
A
parietal (outer) and visceral (inner) of the tunica vaginalis
24
describe the vas deferens
thin muscular tubes that carry sperm from each testicle to the urethra
25
what is the job of the urethra
courses from bladder to end of penis
transports both urine and semen
26
what is a verumontanum
junction of the ejaculatory duct with the urethra
27
describe spermatic cord
```
vas deferens
testicular arteries
venous pampiniform plexus
lymphatics
autonomic nerves
```
28
what arteries arise from the anterior AO just inferior to RA - laterally - low resistance flow
right and left testicular arteries
29
describe the right and left testicular arteries
primary source of blood flow
descend in retroperitoneum
enter spermatic cord
pierce albuginea forming capsular arteries
30
what is the order of the vascular supply of the testicles
testicular arteries --> capsular artery --> centripetal artery --> recurrent rami (centrifugal artery)
31
what supplies the extratesticular
cremateric and deferential
32
venous drainage is from where
pampiniform plexus
33
_____ _____ exits the mediastinum courses through the spermatic cord
pampiniform plexus
34
what 3 veins converge to form the pampiniform plexus
testicular, deferential, and cremasteric
35
right testicular vein drains into the _____
***important***
IVC
36
left testicular vein drains into the _____
***important***
LRV
37
clinical findings for scanning a scrotum
```
palpable mass
scrotal pain
swollen scrotum
trauma
inferility
location / duration
```
38
review protocol for scrotum
slide 40-44
39
at least one image needs to be taken of what???
BOTH testes at the same time for comparison
40
what are color/power doppler parameters
gain - amplify color
PRF - scale - sets Nyguist limit - reduced for slow flow
wall filter - decrease to enhance flow sensitivity
line density
threshold - color priority
packet size
color box size
41
what is done if there is trauma to the scrotum
challenge due to pain and swelling
determine rupture
surgery within 72 hrs - 90% saved
42
what are some complications of trauma to the scrotum
hydrocele and hematocele
hematoma - avascular - no doppler
43
most important goal of US in testicular trauma is to determine if a ______ has occured
rupture
44
_______ _______ are a surgical emergency requiring a prompt diagnosis
ruptured testis
45
if surgery is performed with 72 hrs after injury, up to ____% of testes can be saved, but on _____% can be saved after 72 hrs
90%
45%
46
testicular trauma sonographically
irregular testicular contour
scrotal wall thickening
hematocele
47
describe a hydrocele
fluid formed between the visceral and parietal layers of the tunica vaginalis
48
what technique can easily demonstrate a hydrocele
shining a flashlight through the enlarged portion of the scrotum, if the scrotum is full of clear fluid, it will light up
transillumination
49
describe a hematocele
blood between visceral and parietal vaginalis
low level echos
caused by bleeding of pampiniform plexus or other extratesticular structure - does not confirm rupture
50
hematoceles sonographically
acute - echogenic with echoes
over time - low level echoes with septations
51
describe a hematoma
collection of blood
heterogeneous areas within scrotum, more complex, avascular
may cause displacement of testis
sonographically - "ARROWHEADS"
52
trauma will cause ______ ______ of the testicular parenchymal pattern and an interruption of the ______ ______
focal alteration
tunica albuginea
53
what is epididymitis
an infection
spread of lower UTI or STD's via the spermatic cord
MOST COMMON cause of acute scrotal pain in adults
54
clinical findings of epididymitis
scrotal pain for 1-2 days
fever
urethral discharge
scrotal wall edema
55
epididymitis sonographically
```
enlarged hypoechoic gland
increased flow
increased velocities in systole and diastole
low resistance wave form
hydrocele
```
56
what is orchitis
once the infection has spread to the testicle
associated with hydrocele and pyocele
hyperemic flow - increase color doppler
57
in severe cases of orchitis, ________ ________ may occur and there will be excessive _________
testicular infarction
swelling
58
orchitis when dealing with color doppler, spectral doppler, and doppler waveform
color doppler - decreased or absent flow compared to other testis
spectral doppler - high resistance with little or no diastolic flow
doppler waveform - reversed diastolic flow
59
what is the MOST COMMON etiology of torsion of the spermatic cord
anomaly-bell clapper deformity
60
describe torsion
12-18 yrs old
tunica vaginalis completely surrounds the testis, epididymis and distal spermatic cord - causing a twisting
60% anatomic anomaly on both sides
undescended testes 10x more affected
61
how does a torsion affect blood flow
venous flow with occluded veins
arterial flow obstruction leads to ischemia
62
symptoms of torsion
true emergency
sudden onset of acute pain
swelling
nausea and vomiting
63
torsion of spermatic cord survival rate - surgical emergency
5-6 hrs?
6-12 hrs?
beyond 12 hrs?
5-6 hrs = 80-100% salvage
6-12 hrs = 70%
beyond 12 hrs = 20%
64
what is the MOST COMMON cause of pain in adolescent boys - peak age 14
torsion of spermatic cord
65
how do you doppler a torsed testicle
absence of perfusion
detect low flow set PRF and filter low
compare both sides
66
appearance of torsed testicle...
after 4-6 hours
after 24 hrs
after 4-6 hrs - swollen and hypoechoic
after 24 hrs - heterogeneous
scrotal thickening and hydrocele
67
what is the sign the doctor see's of a torsion of a testicular appendage
"blue dot" sign
will have focal testicular pain
**most common cause of acute scrotal pain in young boys
68
describe epididymal cysts
a cyst is a cyst is a cyst
69
what are spermatoceles
cystic dilation of the efferent duct of the epi
70
describe spermatoceles
located in the epi head
contain proteinaceous fluid and speratozoa
seen often following vasectomy
71
describe tunica albuginea cysts
benign fluid collection
72
what are varicoceles
abn dilation of the veins of the pampiniform plexus within the spermatic cord
73
describe a varicocele
incompetent valves in the spermatic vein
more common 90% - on LEFT side due to association with left renal vein
could be a result of hydronephrosis, mass, liver cirrhosis
74
what is the MOST COMMON correctable thing that you can fix related to infertiliy
varicocele
75
varicocele's have numerous tubules measuring greater than _____ mm and will increase in response to doing a __________
2 mm
valsalva
76
where do hydrocele, pyocele, and hematocele occur
potential space between the visceral and parietal layers of tunica vaginalis
77
what is a hydrocele
serous fluid - painless swelling
78
what is a pyocele
pus filled - abcess
79
what is a hematocele
blood filled - trauma
80
describe tubular ectasia of the rete testis
benign
uncommon
prominent hypoechoic channels - cluster of cystic areas
avascular (do not confuse with varicocele)
81
describe microlithiasis
tiny calcifications in the testicle - echogenic speckles
82
what is microlithiasis associated with
```
cryptorchidism - undescended testicles
infertility
Klinefelter's (genetic)
varicocele
malignancy
```
83
what are malignant masses of the testicles
germ cell tumors
seminoma - MOST COMMON malignancy
cryptorchidism - undescended testicles
84
what are seminoma risk factors
```
cryptorchidism - undescended testicles
family history
infertility
Down syndrome
smoking
white race
```
85
describe germ cell tumor
non seminoma
spread more quickly
high levels of serum
alpha-fetoprotein
86
teratomas are ______ in children and ______ in adults
benign
malignant
87
what is leydig cell tumor
benign in children
may be malignant in adults
non germ cell tumors
88
describe cryptorchidism
```
undescended testicles
originates in the retroperitoneum
located in abd, inguinal canal, or other places
80% palpable in inguinal canal
more common in premature babies
bilateral 10-25%
```
89
what is the surgical treatment for an undescended testicle
orchiopexy
90
what is a scrotal hernia (inguinal)
bowel (most common), omentum, or other structures in scrotum
peristalsis of bowel
91
symptoms of scrotal hernia
scrotal swelling
pain
blood in stool
92
know indirect and direct hernia's
indirect - congenital lesion with a weakness in the bowel which allows the bowel to go through the internal ring; happens to babies
direct - acquired to due stressing a weakness in the bowel which allows the bowel to go through the abd wall; mid-aged, elderly men
