Testicular

Question 1

What are epididymal cysts?

Answer 1

Serous fluid-filled cysts that occur anywhere in the epididymis

They can be palpable if large enough and are separate from the testicle.

Question 2

What is a spermatocele?

Answer 2

Cystic dilatations of the epididymal ductules containing spermatozoa and debris, usually occurring in the head

Spermatocele is often solitary, while epididymal cysts are often multiple.

Question 3

What is a hydrocele?

Answer 3

Abnormal amount of serous fluid in the peritesticular space

It can be unilateral or bilateral and can occur at any age.

Question 4

What are the causes of hydrocele?

Answer 4

• Trauma
• Infection
• Infarction
• Torsion
• Testicular neoplasm

Question 5

What are the sonographic findings of a hydrocele?

Answer 5

Fluid collection next to or around the testis, sometimes with septations

May compress the testis against the inner scrotal wall.

Question 6

What is a varicocele?

Answer 6

A network of dilated veins (pampiniform plexus) due to increased venous pressure

Predominantly found on the left side.

Question 7

What are the sonographic findings of a varicocele?

Answer 7

Dilated fluid-filled tubular structures in the posterolateral aspect of the scrotum measuring greater than 2mm

Increased blood flow with Valsalva maneuver.

Question 8

What is a hematocele?

Answer 8

Collection of blood in the peritesticular space

Considered in patients with a history of recent trauma, torsion, or surgical procedures.

Question 9

What are the sonographic findings of a hematocele?

Answer 9

Complex fluid collection around the testes with possible septations

Varying amounts of cystic vs solid contents depending on the age of the hematoma.

Question 10

What is a pyocele?

Answer 10

Enlarged scrotum with pain, redness, localized warmth, elevated WBC count, and low-grade fever

Sonographic findings include complex, sometimes septated fluid collection surrounding the testis.

Question 11

What are scrotal pearls?

Answer 11

Calcifications within the peritesticular space

Sonographic findings are highly echogenic with possible concentric rings.

Question 12

What is an adenomatoid tumor?

Answer 12

A very commonly found solid mass in the epididymis, benign in nature

Typically hard, discrete extratesticular nodule usually at the tail.

Question 13

What is a scrotal hernia?

Answer 13

Inguinal hernias that enter the scrotum, possibly containing serous fluid, small bowel, colon, mesentery, or omentum

There are two types: direct and indirect, with indirect being more common.

Question 14

What is the significance of differentiating solid vs cystic masses in the scrotum?

Answer 14

Every solid intratesticular mass must be considered malignant until proven otherwise

Scrotal ultrasound approaches 100% accuracy in distinguishing solid from cystic masses.

Question 15

What is a tunica albuginea cyst?

Answer 15

Cysts that form in the tunica albuginea, typically found in men aged 30 to 50

They present as painless and palpable at the testicular surface.

Question 16

What defines a testicular cyst?

Answer 16

Cysts seen within the testicle considered ‘true cysts’, likely originating in the rete testis

They can be tiny or replace entire testicular tissue.

Question 17

What is an epidermoid cyst?

Answer 17

Benign keratin-containing cysts, accounting for 1% of testicular neoplasms

They have an ‘onion skin’ appearance and are painless.

Question 18

What are germ cell tumors?

Answer 18

Most solid intratesticular masses are malignant, including seminomatous and nonseminomatous types

They are usually painless and often present in younger individuals.

Question 19

What is a seminoma?

Answer 19

The most common germ cell tumor, accounting for about half of testicular tumors

They metastasize to retroperitoneal lymph nodes and respond well to treatment.

Question 20

What is embryonal cell carcinoma?

Answer 20

The second most common testicular cancer, typically found in individuals aged 20 to 40

More aggressive than seminomas and can metastasize through bloodstream or lymphatics.

Question 21

What is a teratoma?

Answer 21

Tumors containing teeth, hair, bone, and other tissues, usually benign in younger patients

There is a 30% malignancy rate in older patients.

Question 22

What is choriocarcinoma?

Answer 22

The rarest of germ cell carcinomas, typically seen in ages 10 to 30

Elevated levels of HCG often lead to gynecomastia.

Question 23

What is a Leydig cell tumor?

Answer 23

Also known as interstitial cell tumors, making up 15% of malignant testicular cancers

They typically present as a painless enlargement or palpable mass.

Question 24

What is a Sertoli cell tumor?

Answer 24

Usually benign tumors that can occur at any age, presenting as a large painless palpable mass

Sonographic findings are similar to Leydig cell tumors.

Question 25

What is cryptorchidism?

Answer 25

Absence of one or both testicles from the scrotum, with 80% palpable in the inguinal canal ## Footnote Associated risks include infertility, cancer, and scrotal hernia.

Question 26

What are the common causes of scrotal pain?

Answer 26

Inflammation or torsion ## Footnote Often results from retrograde progression of a urinary tract infection or trauma.

Question 27

What is torsion?

Answer 27

Occurs when the testis rotates within the scrotum, twisting the spermatic cord ## Footnote Sudden severe pain can occur, especially during strenuous activity or sleep.

Question 28

What are the sonographic findings in testicular torsion?

Answer 28

Enlarged hypoechoic testis with diminished high-resistance arterial flow ## Footnote The 'whirlpool sign' is often observed posterior to the testicle.

Question 29

What is a testicular hematoma?

Answer 29

Bleeding within a testicle, presenting as a painful scrotum ## Footnote It may show heterogeneous appearance with possible septations.

Question 30

What is a testicular infarct?

Answer 30

Occurs after focal or diffuse ischemia of the testicle ## Footnote Typically presents with a focal hypoechoic mass.

Question 31

What is testicular rupture?

Answer 31

A condition where the tunica albuginea is ripped or cut due to trauma ## Footnote It is a urologic emergency with a 90% salvage rate if treated surgically.

Question 32

What is the primary imaging technique used for testicular screening?

Answer 32

Ultrasound ## Footnote Ultrasound is the primary tool for testicular screening for most pathologies.

Question 33

What structures are contained within the scrotum?

Answer 33

* Testicles * Epididymides * Spermatic cords ## Footnote These structures are essential for male reproductive function.

Question 34

What is the normal size of the testicle?

Answer 34

Approximately 5cm x 3cm x 2cm ## Footnote This size is used as a reference for normal testicular anatomy.

Question 35

What is the echogenicity of the testicle on ultrasound?

Answer 35

Homogeneous and mildly echogenic ## Footnote The mediastinum testis appears hyperechoic.

Question 36

What is the anatomy of the epididymis divided into?

Answer 36

* Head * Body * Tail ## Footnote The epididymis is a tubular structure that courses posterior-lateral to the testis.

Question 37

What is the typical length of the epididymis?

Answer 37

6cm – 7cm ## Footnote The head of the epididymis may be more echogenic than the rest.

Question 38

Where is the head of the epididymis located?

Answer 38

Superior to the upper pole of the testicle ## Footnote The head is the largest part of the epididymis, measuring 6mm to 15mm in width.

Question 39

What arteries provide blood flow to the testicle?

Answer 39

* Testicular arteries * Capsular arteries * Centripetal arteries * Centrifugal arteries ## Footnote These arteries originate from the abdominal aorta and provide vital blood supply to the testes.

Question 40

What is the appearance of centrifugal arteries on color Doppler exam?

Answer 40

Candy cane appearance ## Footnote This appearance is due to the branching of the arteries into arterioles and capillaries.

Question 41

What are some pathologies that can be detected with a testicular ultrasound?

Answer 41

* Inflammatory processes of the testes & epididymis * Tumors * Trauma * Torsion * Hydrocele * Varicocele * Hernias * Spermatoceles * Undescended testes ## Footnote These pathologies can affect testicular health and require thorough evaluation.

Question 42

What should be the appearance of the testicular parenchyma on ultrasound?

Answer 42

Uniform with equal echogenicity bilaterally ## Footnote This indicates normal testicular health.

Question 43

What planes should the ultrasound scan be conducted in for the testicles?

Answer 43

* Sagittal * Transverse ## Footnote Scanning in two planes helps in accurate measurement and evaluation.

Question 44

What is the purpose of using Color Doppler in testicular ultrasound?

Answer 44

To assess blood flow ## Footnote Color Doppler should be applied to both testicles for a comprehensive evaluation.

Question 45

True or False: The peritesticular space normally contains a large amount of serous fluid.

Answer 45

False ## Footnote The peritesticular space normally contains a small amount of serous fluid.

Question 46

What is the measurement process for testicles during an ultrasound?

Answer 46

Measure in mid plane in both sagittal & transverse ## Footnote This ensures consistent and accurate size assessment.

Question 47

Fill in the blank: The tunica albuginea is _______.

Answer 47

[a fibrous connective tissue encapsulating the testicles] ## Footnote This structure provides support to the testicles.