Scrotum Flashcards
1
Q
pouch of loose skin and fascia continous with abdomen
A
scrotum
2
Q
divides scrotum into 2 compartments
A
midline raphe
3
Q
forms internal scrotal septum
A
dartos tunica
4
Q
thickness of scrotal wall
A
2-8 mm
5
Q
lining of scrotal sac
A
tunica vaginalis (visceral, parietal)
6
Q
normal amount of fluid between layers
A
1-2 mL
7
Q
paired reproductive organs
A
testes
8
Q
function of testicles
A
produce sperm and testosterone
9
Q
fibrous layer surrounding each testicle
A
tunica albuginea
10
Q
tunica albuginea forms ___ posteriorly
A
mediastinum
11
Q
invagination of tunica albuginea creates
A
lobules
12
Q
number of lobules per testicle
A
250-400
13
Q
lobules contain
A
seminiferous tubules
14
Q
seminiferous tubules are the site of
A
spermatogenesis
15
Q
convergence of thin septations of tunica albuginea
A
mediastinum
16
Q
mediastinum is located
A
posterior testes
17
Q
convergence of ductules at mediastinum
A
rete teste
18
Q
rete teste forms
A
efferent ducts
19
Q
tubules within mediastinum
A
rete teste
20
Q
function of rete teste
A
carry seminal fluid to epididymis
21
Q
area not covered by peritoneum, small portion of posterior testes and epi
A
bare area
22
Q
rete teste is tethered to what by what
A
scrotal wall, by visceral tunica vaginalis
23
Q
mullerian duct remnant
A
appendix testis
24
Q
appendix testis usually located
A
on UP
25
paramesonephric duct
mullerian duct
26
mullerian duct
paramesonephric duct
27
epi head is located
superior to testicle
28
epi body is located
posterolateral to testes
29
epi tail is located
inferior to testicle
30
epi tail empties into
vas deferens
31
length of epididymis
6-7 cm
32
epi head aka
globus major
33
epi tail aka
globus minor
34
epididymis function
conveys sperm to seminal vesicles, storage and maturation of sperm
35
remnant of mesonephric duct
appendix epididymis
36
mesonephric duct
Wolfian duct
37
Wolfian duct
mesonephric duct
38
seminal vesicles function
reservoir for seminal fluid
39
connects testes to pelvis and adbomen
spermatic cord
40
suspends testes in scrotum
spermatic cord
41
travels in inguinal canal
spermatic cord
42
spermatic cord contains
vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, nerves
43
right testicular vein drains into
IVC
44
left testicular vein drains into
left renal vein
45
waveform of testicular artery
low res
46
waveform of cremasteric & deferential arteries
high res
47
indications for scrotal exam
palpable mass, swelling, pain, cyst vs solid mass, torsion
48
echogenicity of testes
homogeneous, medium level echoes, similar to thyroid
49
echogenicity of testes ___ with age
increases
50
hyperechoic band from SUP to INF pole in SAG
mediastinum
51
hyperechoic mass at 3 o'clock in right testicle, 9 o'clock in left testicle
mediastinum
52
decreased echogenicity at mediastinum of tiny cystic structures
rete teste
53
isoechoic or slightly hyperechoic to testicle
epididymis
54
coarse echotexture
epididymis
55
undescended testicle
cryptorchidism
56
failure of testicles to descend to normal position
cryptorchidism
57
higher incidence of cryptorchidism in
premature infants
58
most common GU abn in children
cryptorchidism
59
cryptorchidism is usually
unilateral
60
structure that guides and anchors testis during descent into scrotal sac
gubernaculum
61
causes of cryptorchidism
deficiency of gonadotropin hormonal stimulation in utero, adhesions, anatomic maldevelopments, idiopathic
62
complete descent of testis is needed for
full maturation, fertility
63
cryptorchidism complications
infertility, testicular cancer
64
rate of testicular cancer in pt with cryptorchidism
48 X
65
testicular cancer can occur in _____ with cryptorchidism
BOTH testes
66
surgical repair of cryptorchidism
orchiopexy
67
removal of testicle
orchiectomy
68
cryptorchidism fixed under 2 yrs old will remain
fertile
69
cryptorchidism fixed after 2 yrs old will be
infertile
70
U/S appearance of ectopic testis
smaller, less echogenic, homogeneous, mediastinum difficult to id
71
ectopic testis can be mistaken for
LN
72
testicular duplication
polyorchidism
73
supernumary testis
polyorchidism
74
most common form of polyorchidism
unilateral, in scrotum ( 2 testis in 1 sac)
75
absence of testicle
anorchia
76
anorchia is more common on which side
left side
77
testicular ectopia can occur
anywhere along path of descent
78
most common cause of painless scrotal swelling
hydrocele
79
collection of fluid between tunica vaginalis layers > 2 mm
hydrocele
80
hydrocele occur usually
anterolateral potion of scrotum
81
congenital cause of hydrocele
patent processus vaginalis
82
congenital hydrocele occurs in
young children/babies usually resolves 18-24 months
83
most common cause of hydrocele
idiopathic, acquired
84
acquired hydrocele
idiopathic
85
acquired hydrocele can be due to
infarction, neoplasm, trauma, inflammation,
86
large hydrocele is usually associated with
benign findings
87
small hydrocele is usually associated with
malignant neoplasms - 60 %
88
hydroceles may contain
septations, debris, calcifications - scrotal pearls
89
blood in scrotal sac
hematocele
90
hematocele can be due to
trauma, sx, neoplasm, torsion
91
clinical presentation of hematocele may mimic
epididymitis, torsion
92
acute hematocele on U/S
scrotal wall thickening, anechoic thickening
93
chronic hematocele on U/S
sepatations, debris
94
pus in scrotal sac
pyocele
95
cause of pyocele
abscess rupture into tunica vaginalis potential space
96
U/S appearance of pyocele
echogenic collections, sepatations/loculations, thick scrotal wall, focal mural calcs
97
abnormal dilated veins of pampiniform plexus
varicocele
98
Nutcracker syndrome
LRV passes under SMA which compress it, blocking drainage of spermatic vein
99
size of varicocele
> 2 mm
100
varicocele is due to
obstructed venous return
101
varicoceles typically occur on
left side
102
varicoceles typically occur on left because
increased length of left testicular vein, crosses over aorta
103
primary varicocele
idiopathic
104
primary varicocele age group
15-25
105
most common cause of correctible infertility
primary varicocele
106
primary varicocele due to
incompetent valves in internal spermatic vein
107
cause of secondary varicocele
increased pressure on the spermatic vein
108
effect of Valsalva on varicocele
increase size of vein, increased or reversed flow
109
primary varicocele will ___ in supine
return to normal
110
valsalva will NOT change appearance of
secondary varicocele
111
varicocele size
> 2 mm
112
location of varicocele
prox to UP, use colour
113
inguinal hernia that descends into scrotum
scrotal hernia
114
scrotal hernia contains
omentum, bowel
115
scrotal hernia associated with
heavy lifting
116
S/S of scrotal hernia
enlargement, pain, blood in stool
117
U/S of scrotal hernia
mass outside testicle, echogenic or anechoic, peristalsis if not incarcerated
118
scrotal trauma is due to
direct injury, straddle fall
119
scrotal trauma can cause
hematoma, hematocele, ruptured testicle
120
ruptured testicle surgical repair
repair tunica, remove testicle
121
tunica albuginea tear
ruptured testicle
122
most common cause of ruptured testicle
blunt trauma
123
90% of testicular tissue can be salvaged within
72 hrs
124
if ruptured testicle not repaired
loss of function, atrophy
125
U/S features of ruptured testicle
focal areas of altered echogenicity, irregular capsule/contour, hematocele,
126
spermatic cord twists, cutting off blood supply to testicle
torsion
127
weakening in mesenteric attachement from spermatic cord to testicle
torsion
128
testicular torsion is common in males
< 25 yrs
129
surgery done < 6 hrs after torsion
80-100 % saved
130
complete infarct after
12 hrs
131
acute torsion
within 24 hrs
132
subacute torsion
24 hrs - 10 days
133
chronic torsion
> 10 days
134
two types of torsion
extra-vaginal, intra-vaginal (Bell- Clappers)
135
extra-vaginal torsion
at level of external inguinal ring
136
extra-vaginal torsion occurs in
neonates
137
intra-vaginal torsion
Bell-Clapper's deformity
138
intra-vaginal torsion occurs in
adolescents, young adults
139
more common type of torsion
intra-vaginal
140
Bell Clapper's deformity
intra-vaginal torsion
141
extra-vaginal torsion due to
poor/absent attachment of testis to scrotal wall
142
in extra-vaginal torsion which things twist?
both tunica vaginalis and spermatic cord twist together
143
U/S of acute torsion
enlarged testicle + epididymis, hypoechoic, scrotal skin thickening, reactive hydrocele, no flow
144
U/S of subacute torsion
enlarged but heterogeneous
145
U/S of chronic torsion
atrophied, heterogeneous, hydrocele
146
in all stages of torsion, the ____ always remains enlarged
epididymis
147
torsion S/S may mimic
epididymitis
148
symptoms of torsion will diminish because
tissue is dead
149
symptoms of epididymitis will persist because
living tissue ongoing infection
150
inflammation/infection of epididymis
epididymitis
151
origin of epididymitis
bladder, urethra, prostate
152
most common origin of epididymitis
urethra
153
most common cause of acute scrotal pain and tenderness in adults
epididymitis
154
epididymitis can cause
infertility
155
epididymitis is typically
unilateral
156
painful urination
dysuria
157
U/S of epididymitis
thick, enlarged epididymitis, hypoechoic, hetergeneous, scrotal thickening, reactive hydrocele, increased flow compared to contralateral side, abscess
158
if untreated epididymitis can lead to
spread to testicle -> epididymo-orchitis
159
inflammation of testis
orchitis
160
orchitis can be
focal or diffuse
161
most common cause of orchitis in men < 35
chlamydia
162
orchitis is typically secondary to
epididymitis
163
orchitis may appear like a
neoplasm
164
U/S appearance of orchitis
```
focal= hypo area, enlarged epi, increased blood flow,
diffuse = decreased echogenicity, enlarged testicle,
chronic = hypo, hetero, +/- hydrocele
```
165
common result of untreated epididymo-orchitis
abscess
166
testicular abscess symptoms
pain, fever, swollen scrotum
167
testicular abscess rupture
fistula to skin
168
testicular abscess associated with
diabetes, mumps, influenza
169
abcess flow will look like
increased flow in periphery
170
calcifications floating on tunica or within scrotal sac
scrotal pearls
171
scrotal pearls are
mobile
172
retention cyst
spermatocele
173
dilated epididymal tubules
spermatocele
174
spermatocele is filled with
non-viable sperm
175
spermatocele can result from
trauma, epidiymitis
176
spermatocele typically located
at epi head
177
spermatocele can
displace testicle
178
spermatoceles are common in
middle aged men
179
spermatocele S/S
painless scrotal swelling
180
pt with spermatocele present with
palpable lump
181
U/S of spermatocele
well-defined, anechoic mass with post enhancement, simple, loculated, septated, echogenic debris
182
true cysts are
extremely rare
183
true cysts are
aymptomatic
184
what 2 things CANNOT be differentiated sonographically
spermatocele and true cyst
185
true cyst in epi are
uncommon
186
true cyst in tunica albuginea are
rare
187
10 % of true cysts are found in
UP
188
less than 5% of testicular tumours are
non-germ cell neoplasm
189
occur in men 20-50 yrs
non-germ cell neoplasm
190
non-germ cell neoplasms include
Sertoli, Leydig cell tumours
191
S/S of Sertoli, Leydig cell tumours
gynecomastia, feminization
192
U/S appearance of Sertoli, Leydig cell tumours
hypoechoic area within testicle
193
most common extratesticular tumour
adenomatoid tumour
194
neoplams typically in epididymis
adenomatoid tumour
195
characteristic of adenomatoid tumour
slow-growing, asymptomatic, small
196
U/S of adenomatoid tumour
well-defined, variable echogenicity, solid, unilateral, usually LEFT side
197
adenomatoid tumours usually occur on
LEFT side
198
calcifications in seminiferous tubules
microlithiasis
199
5 or fewer microcalcs
isolated microlithiasis
200
isolated microlithiasis is associated with
benign conditions
201
isolated microlithiasis can be caused by
inflammatory, granulomatous, vascular processes
202
greater than 5 microcalcs is associated with
malignant neoplasm development
203
microlithiasis has no
posterior shadowing
204
presentation of malignant pathologies
painless scrotal enlargement, hardness of testicle
205
malignant pathologies are usually
unilateral, hypoechoic
206
most common cause of death of men 15-34 yrs
testicular neoplasm
207
testicular neoplasms originate from
germ cell
208
testicular neoplasms are divided into
seminomas, non-seminomatous tumours
209
__% of testicular neoplasms have
10%, small reactive hydrocele
210
with malignant neoplasm, scrotal was and epi will be
normal thickness, normal
211
most common germ cell tumour
seminoma
212
seminomas occur in which age group
30-40 yrs
213
seminoma is associated with
undescended testicle (cryptorchidism)
214
least aggressive, best prognosis
seminoma
215
seminoma has ___ AFP
normal
216
seminoma has ___ beta hCG
may be elevated
217
U/S features of seminoma
solid, homogeneous, hypo, scattered hyper areas, microlithiasis, pseudocapsule
218
NSGCT
non-seminomatous germ cell tumour (category)
219
NSGCT affects
younger pts
220
more aggressive, visceral mets
NSGCT
221
NSGCT includes
embryonal cell CA, chorioCA, teratoma, yolk sac tumour, mixed germ cell tumour
222
2nd most common testicular tumour
embryonal cell CA
223
embryonal cell CA occurs in
25-35 yrs
224
embryonal cell CA frequently occur in combo with
other tumours
225
most aggressive tumour
embryonal cell CA
226
embryonal cell CA has mets/invasion
in tunica albuginea
227
embryonal cell CA _____ AFP
may or may not be elevated
228
U/S of embryonal cell CA
hypo mass, hyper areas, cystic areas, poorly defined, irregular
229
infantile form of embryonal cell CA
yolk sac tumour
230
AFP ALWAYS elevated in
yolk sac tumour
231
sreum beta hCG ALWAYS elevated in
choriocarcinoma
232
highly malignant and aggressive test. tumour
choriocarcinoma
233
choriocarcinoma occurs in
20-30 yrs
234
high incidence of pulmonary involvement
choriocarcinoma
235
poor prognosis
choriocarcinoma
236
present with gynecomastia, scrotal pain
choriocarcinoma
237
U/S of choriocarcinoma
small mass, mixed echogen., irregular borders, mixed components
238
rare scrotal malignancy
teratoma
239
benign in children, malignant in adults
teratoma
240
AFP, beta hCG levels in teratoma
may be elevated (esp if malignant)
241
U/S of teratoma
cystic + solid components, post. shadow + enhancement, defined borders, calcs
242
most common type is teratocarcinoma
mixed germ cell
243
teratocarcinoma contains
teratoma + embryonal ca cells
244
largest of all testicular tumours
teratocarcinoma
245
heterogeneous mass with cystic areas and echogenic foci
teratocarcinoma
246
burned out tumour
echogenic/calcified scar in testicle
247
burned out tumour represents
regression of a primary testicular tumour. tumour outgrows blood supply, regresses
248
most common mets to teste
lymphoma
249
lymphoma occurs in men
> 50 yrs
250
most common type of lymphoma
non-Hodgkins
251
presentation of testicular lymphoma
painless testicular mass, OR diffuse enlargement of testicle (most common)
252
sono. appearance of testicular lymphoma
hypo, homogeneous, increased vascularity, diffuse or focal
253
kidney appearance with lymphoma
diffusely enlarged, hypo
254
second most common testicular neoplasm
leukemia,
255
2 most common non-lymphomatous mets to testicle
prostate, lung
256
4 routes of mets spread to testes
retrograde venous, hematogenous, lymphatic, direct invasion
257
post vasectomy changes occur in
epididymal changes
258
post vasectomy epididymal changes
enlargement, heterogeneous, cysts/spermatocele, sperm granulomas, tubular ectasia
259
tubular ectasia involves
rete testis or epi
260
tubular ectasia occurs in
mediastinum + epi
261
tubular ectasia will have ___ flow
NO flow
262
tubular ectasia often associated with
spermatocele
263
use colour to differentiate between
tubular ectasia , varicocele
264
tubular ectasia is frequently
bilateral, asymmetrical
265
post orchiectomy assessment
scrotal space - hematomas, abcess, recurrent neoplsm, prosthesis
266
innermost layer surrounding testis
tunica albuginea
267
has visceral and parietal layers
tunica albuginea
268
outermost layer surrounding testis
tunica vaginalis
