Scrotum Flashcards
1
Q
role of sonography in evaluating the scrotum
A
Differentiate between intratesticular and extratesticular masses, Differentiate between cystic and solid masses, Evaluation of suspected testicular torsion, Evaluation of suspected testicular infection
2
Q
shape of testis
A
Symmetric, oval shaped glands residing in the scrotum
3
Q
size of testis
A
3 to 5 cm x 2 to 4 cm x 3 cm
4
Q
Testis is divided into _____ conical lobules containing the seminiferous tubules
A
> 250 to 400
5
Q
where is sperm created
A
seminiferous tubules
6
Q
seminiferous tubules converge at apex of each lobule and anastomose (join) to form _______
A
rete testis in mediastinum.
7
Q
Rete testis drains into ______ through efferent ductules
A
head of epididymis
8
Q
sonographic appearance of testis
A
Smooth, medium gray structures with fine echo texture
9
Q
Protrusion off the upper pole of the testis, located between the testis and the epididymis
A
appendix testis
10
Q
size of epididymis
A
6 to 7 mm
11
Q
Shape of epididymis
A
Tubular structure.
12
Q
epididymis divided into
A
head, body, and tail
13
Q
location of epididymis
A
Superior to upper pole of testis.
14
Q
epididymis runs ________ to testis
A
superiorly posterolaterally
15
Q
epididymis contains 10 to 15 efferent ductules from rete testis, which converge to form _________
A
single duct in body and tail, known as ductus epididymis.
16
Q
ductus epididymis becomes _______
A
vas deferens and continues in spermatic cord
17
Q
largest portion of epididymis
A
head
18
Q
Smaller than the head of epididymis, Can be difficult to see sonographically. and Follows posterolateral aspect of testis from upper to lower pole
A
body of epididymis
19
Q
Slightly larger than the body of epididymis and Positioned posterior to lower pole of testis
A
tail of epididymis
20
Q
Small protuberance from head of epididymis
A
appendix epididymis
21
Q
sonographic appearance of epididymis
A
Isoechoic or hypoechoic compared with testis, Echo texture coarser than testis
22
Q
Dense, fibrous tissue that completely covers the testis
A
tunica albuginea
23
Q
Posterior aspect of tunica albuginea reflects into testis to form vertical septum known as ________-
A
mediastinum testis
24
Q
Multiple septa, or divisions, (known as the __________) are formed from tunica albuginea at mediastinum
A
septa testis
25
septa within testis separate it into _______
lobules
26
Mediastinum supports _______ coursing within testis
vessels and ducts
27
sonographic appearance of mediastinum testis
Bright, hyperechoic line coursing craniocaudad within testis
28
Lines the inner walls of scrotum, covering each testis and epididymis.
tunica vaginalis
29
tunica vaginalis consists of two layers: _______
parietal (inner lining of scrotal wall) and visceral (surrounds testis & epi)
30
bare area located where
posteriorly
31
________is the point where the testicle is against the scrotal wall, preventing torsion
bare area
32
________ travel through bare area
Blood vessels, lymphatics, nerves, spermatic ducts
33
where do hydroceles form
Between the layers of the tunica vaginalis.
34
A continuation of the ductus epididymis
vas deferens
35
vas deferens dilates where
at terminal portion near seminal vesicles, known as the ampulla
36
Vas deferens joins the duct of seminal vesicles to form _______, which empties into urethra
the ejaculatory duct
37
Urethra courses from ______ to ________
bladder to end of penis
38
In men, urethra transports _______ outside body.
both urine and semen
39
Extends from scrotum through inguinal canal and internal inguinal rings to pelvis.
spermatic cord
40
spermatic cord consist of
Vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, autonomic nerves, and fiber of cremaster
41
function of spermatic cord
suspends the testes in the scrotum
42
Primary source of blood flow to testis
right and left testicular arteries
43
testicular arteries arise from
abdominal aorta
44
testicular arteries descend in the retroperitoneum and enter the ______
spermatic cord
45
testicular arteries course along posterior surface of testis and pierce ________
tunica albuginea
46
testicular arteries form or give rise to ________
capsular arteries
47
centripetal arteries course
from testicular surface toward mediastinum along the septa
48
centrifugal arteries branch further into ________
arterioles and capillaries
49
capsular arteries give rise to
centripetal arteries
50
Before reaching the mediastinum, centripetal arteries curve backward forming _______
recurrent rami (centrifugal arteries)
51
capsular and centrifugal arteries show a _________ waveform
low resistance
52
__________ Accompany testicular artery within spermatic cord to supply extratesticular structures
cremasteric and deferential
53
__________ Have anastomoses with testicular artery and may provide some flow to testis
cremasteric and deferential
54
venous drainage of testis occurs through
veins of pampiniform plexus
55
Pampiniform plexus exits from _________ and courses in spermatic cord
mediastinum testis
56
prep for sonographic evaluation of scrotum
none
57
transducer to use for evaluation of scrotum
High-frequency (8 to 12 MHz) linear-array
58
Scrotum is often painful & swollen with ________
scrotal trauma
59
scrotal trauma is often the result of ______
MVA, Athletic injury, Direct trauma to scrotum, Straddle injury
60
goal of sonography in evaluating a patient with scrotal trauma
Determine if rupture is present.
61
_____ of testicular ruptures can be saved if surgery is within 72 hours
90%
62
________ of testicular ruptures can be saved after 72 hours
45%
63
complication of scrotal trauma include
Hydrocele and hematocele
64
sonographic appearance of scrotal trauma/rupture
Focal alteration of testicular parenchymal pattern, Interruption of tunica albuginea, Irregular testicular contour, Scrotal wall thickening, Hematocele
65
sonographic appearance of hematocele
Varies with age
66
sonographic appearance of acute hematocele
echogenic with numerous, highly visible echoes that can be seen to float or move in real time
67
sonographic evaluation of hematocele that ages over time
low-level echoes and develop fluid-fluid levels or septations
68
Heterogeneous areas within scrotum that may be large and cause displacement of the associated testis, may involve testis or epididymis or contained within scrotal wall
hematoma
69
color doppler can be useful to distinguish areas of hematoma, especially when involving testis, because color doppler will show _____
no flow
70
Infection of epididymis and testis.
epididymo-orchitis
71
MOST COMMON CAUSE OF ACUTE SCROTAL PAIN IN ADULTS
epididymo-orchitis
72
most common cause of epididymo-orchitis
spread of lower urinary tract infection via spermatic cord
73
other causes of epididymo-orchitis
Mumps, Syphilis, TB, Viral, and Trauma
74
clinical findings of epididymo-orhitis
Increasing scrotal pain x 1 to 2 days, Pain may be mild to severe, May have fever & urethral discharge
75
sonographic findings of epididymo-orchitis
Enlarged, hypoechoic gland
If secondary hemorrhage has occurred, epididymis may contain focal hyperechoic areas.
Hyperemic flow confirmed with color Doppler
Scrotal wall thickening
Hydrocele (anechoic or contain low-level echoes)
Complex hydroceles (containing thick septations and low level echoes) may be associated with severe epididymitis and orchitis.
76
If infection isolated to epididymis: testicle will appear _______
normal
77
normal
enlarged testis, heterogeneous and slightly hypoechoic
78
_____ is result of abnormal mobility of testis within scrotum
torsion
79
MOST COMMON CAUSE OF ACUTE SCROTAL PAIN IN ADOLESCENTS
torsion
80
most common cause of torsion
bell clapper deformity
81
with ________, tunica vaginalis completely surrounds testis, epididymis, distal spermatic cord (instead of having the bare area where they are fixed to the scrotal wall), allowing them to move and rotate freely within scrotum.
bell clapper deformity
82
salvageability rate of torsion within 5-6 hours
80% to 100%
83
salvageability rate of torsion within 6-12 hours
70%
84
salvageability rate of torsion after 12 hours hours
20%
85
with torsion, _________ twist within scrotum, cutting off vascular supply within spermatic cord.
testis and epididymis
86
Up to _______ of torsion patients have anatomic anomaly on both sides
60%
87
Undescended testes are _______ than normal testes to be affected by torsion
10 times more likely
88
with torsion, _______ flow affected first, causing swelling of scrotal structures on affected side
Venous
89
If torsion continues, arterial flow obstructed and ________
testicular ischemia (inadequate blood supply) follows
90
peak incidence age of torsion
14
91
clinical symptoms of torsion
Sudden onset of scrotal pain with swelling on affected side
Severe pain causes nausea and vomiting in many patients
Frequently reported incidences of previous scrotal pain
92
sonographic findings of torsion
Vary depending on how much time has passed
Early stages may appear normal
After 4 to 6 hours: swollen, hypoechoic testis
After 24 hours: heterogeneous testicle as result of hemorrhage, infarction, and necrosis
Scrotal skin thickening
Hydrocele
ABSENCE OF COLOR DOPPLER
Decreased color doppler flow may be seen when torsion is intermittent
93
extratesticular cysts consist of
epididymal cysts, spermatoceles, and tunica albuginea cysts
94
Most scrotal cysts are _______, found in tunica albuginea or epididymis.
extratesticular
95
clinical findings of extratesticular cysts
Generally asymptomatic. May be palpable
96
Cystic dilations of efferent ductules in epididymis:
spermatocele
97
location of spermatocele
Always in epididymal head
98
_______ may be seen more often following vasectomy
spermatocele
99
spermatoceles contain
Proteinaceous fluid and spermatozoa
100
location of epididymal cyst
Can be found ANYWHERE in the epididymis
101
epididymal cysts contain
serous fluid
102
Abnormal dilation of veins of pampiniform plexus (located within spermatic cord).
varicocele
103
varicocele more common on the
left
104
varicocele associated with
impaired fertility
105
_________ Caused by incompetent venous valves within spermatic vein
primary varicocele
106
_________ Caused by increased pressure on spermatic vein which may be result of renal hydronephrosis, abdominal mass, or liver cirrhosis. Abdominal malignancy invading left renal vein may cause varicocele with non-compressible veins
secondary varicoceles
107
ANY non-compressible varicocele in a man older than 40 should prompt search for ________
retroperitoneal mass
108
sonographic findings of varicocele
Tortuous tubes of varying sizes within spermatic cord near epididymal head.
Tubes may contain echoes that move with real-time imaging (blood flow)
Varicoceles measure > 2 mm in diameter.
Tend to increase in diameter in response to Valsalva maneuver
109
a ________ is when Bowel, omentum, or other structures herniate into scrotum.
scrotal hernia
110
sonographic findings of scrotal hernia
Peristalsis of the bowel, seen with real-time imaging, in the scrotal sac confirms the diagnosis of a scrotal hernia.
If peristalsis not seen, air-filled loops of bowel may be present showing a dirty acoustic shadow
111
MOST COMMON CAUSE OF PAINLESS SCROTAL SWELLING
hydrocele
112
hydroceles contain
serous fluid
113
hydroceles may be idiopathic (cause unknown), but commonly associated with ________
epididymo-orchitis and torsion
114
sonographic findings of hydrocele
Fluid filled collection located outside the anterolateral aspect of testis
Anechoic
May contain low-level echoes
115
Collection of pus.
pyocele
116
________ Occur with untreated infection or when an abscess ruptures into space between layers of tunica vaginalis
pyoceles
117
pyoceles are indistinguishable from ______
hematoceles
118
sonographic findings of pyoceles
Fluid collection containing internal echoes
Thickened septations
Loculations
119
Collection of blood associated with trauma, surgery, neoplasms, or torsion.
hematocele
120
sonographic findings of hematocele
Fluid collection containing internal echoes
Thickened septations
Loculations
121
________ Occur as chronic inflammatory reaction to leakage of sperm.
spermatic granuloma
122
________ Most frequently seen in patients with history of vasectomy
spermatic granuloma
123
Most frequently seen in patients with history of vasectomy
spermatic granuloma
124
Sperm granuloma may be located ________
anywhere within epididymis or vas deferens
125
spermatic granulomas Can NOT be reliably differentiated from ________
epididymal tumors
126
sonographic findings of spermatic granuloma
Well defined, solid mass
May be hypoechoic or isoechoic to epididymis
Often heterogeneous
Increased vascularity may be seen
127
tubular ectasia benign or malignant
benign
128
__________ is Associated with presence of a spermatocele, epididymal, or testicular cyst or other epididymal obstruction on same side as dilated tubules
tubular ectasia of the rete testis
129
sonographic findings of tubular ectasia of the rete testis
Tiny tubular structures near mediastinum
Prominent hypoechoic channels near echogenic mediastinum
Avascular (no color Doppler seen)
130
testicular cysts are more common in men _______
over 40 years old
131
testicular cysts associated with
extratesticular spermatoceles
132
testicular cysts located
near mediastinum
133
sonographic findings of testicular cysts
characteristics of a cyst
134
Tiny calcifications in the testis
microlithiasis
135
characteristics of microlithiasis
Smaller < 3 mm.
Usually bilateral condition
Reported to have association with testicular malignancy; exact nature unknown
136
testicular cancer prognosis
one of most curable forms of cancer
137
testicular cancer more common in whom
caucasian men
138
testicular cancer occurs most frequently between ages
20 and 34
139
extratesticular masses are usually
benign
140
intratesticular masses are usually
malignant
141
clinical findings of testicular cancer
Painless lump
Testicular enlargement
Vague discomfort in scrotum
142
classification of testicular mass is either
germ cell or non germ cell
143
germ cell tumors are associated with elevated levels of
human chorionic gonadotropin and alphafetoprotein
144
germ cell tumors account for ______ of all testicular tumors
95%
145
germ cell tumors are highly
malignant
146
most common germ cell tumor
seminoma
147
types of germ cell tumors
Seminoma, Mixed embryonal cell, Teratocarcinoma, Yolk sac, Choriocarcinoma, Teratoma
148
non germ cell tumors are generally
benign
149
Most common testicular cancer
Seminoma
150
sonographic findings of seminoma
Focal, hypoechoic masses, Homogeneous, Smooth border
151
sonographic findings of embryonal cell tumors
More aggressive than seminoma, Heterogeneous, Less well-circumscribed, Areas of calcification, hemorrhage, fibrosis, Cystic components
152
sonographic findings of teratoma
Heterogeneous, Well-defined borders, May show dense foci that produce acoustic shadowing
153
sonographic findings of choriocarcinoma
Varies due to mixed cell types, Appearance is determined by predominant cell type present, Irregular borders
154
how common are mets to the testicles
rare, usually occurring later in life
155
Metastasis to testicle is ______, with multiple lesions found.
bilateral
156
with mets, the primary tumor may originate from
Prostate or kidneys; less common sites include lung, pancreas, bladder, colon, thyroid, or melanoma
157
sonographic findings of metastasis to the testicles
Solid hypoechoic mass, Hyperechoic, Mixture of both
158
Most common bilateral secondary testicular neoplasm affecting men > 60 years
malignant lymphoma
159
Involvement of testicle is 2nd most common secondary testicular neoplasm of __________. Most often found in children
leukemia
160
cryptorchidism aka
undescended testicle
161
During fetal growth, testes first appear in ________
retroperitoneum near kidneys
162
Testes should descend into scrotum from inguinal canal ______
shortly before birth or early in neonatal period
163
cryptorchidism more common in whom
premature babies
164
location of undescended testis may be
in abdomen, inguinal canal or other ectopic location
165
treatment for cryptorchidism
Orchiopexy: testis is pulled down into scrotum and fixed to scrotal wall
166
sonographic findings of cryptorchidism
Undescended testis: smaller and less echogenic than normal testis
Usually oval with homogeneous texture
Mediastinum rarely seen
167
with ________ Ectopic testicle cannot be manipulated into correct path of descent.
testicular ectopia
168
Most common site for ectopic testicle to rest is ________.
superficial inguinal pouch
169
anorchia more common on
left side
170
definitive diagnosis of anorchia depends on
surgical diagnosis
171
causes of anorchia
Intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero
172
Testicular Duplication
Polyorchidism
173
polyorchidism more common on
left side
174
Increased incidence of ________ with polyorchidism
malignancy, cryptorchidism, inguinal hernia, torsion
