Testicular Flashcards

0
Q

What is the appendix epididymis

A

A detached efferent duct. It’s seen as a small soft projection off the epididymis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What is the appendix testis

A

Ruminant of the mullerian duct. A small ovoid structure near head of epididymis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the tunica albuginea and tunica vaginalis

A

Albuginea: fibrous capsule that surrounds the testicle

Vaginalis:
the inner/visceral layer. It covers the testicle and epididymis.
The outer/parietal layer lines the walls of the scrotal chamber. A small amount of fluid is commonly seen in this space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hydrocele

A

Collection of fluid in tunica vaginalis

Fluid collection surrounding the testicle.

Congenital/acquired

MC fluid collection in scrotum
MC in newborns

Idiopathic, trauma, infection, infarct, torsion, neoplasm

Fluid collection, enhancement, wall thick, scrotal pearls, septations with old hemorrhage/infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Varicocele

A

Dilated tortuous veins of the pampiniform plexus located posterior to the testis and assoc with male infertility.

Caused by incompetent valves of the internal spermatic vein

MC on left, distend when valsalva or abd compression

Pamp plexus > 2 mm

Infertility, warm temp scrotum, tubular serpiginous veins, > 2 mm, inc with valsalva in upright position.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Difference between epididymal cyst and spermatocele

A

Both result from dilatation of the epididymal tubules

Epi cyst are composed of clear fluid.

Spermatoceles are filled with thick milky fluid containing spermatozoa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 MC causes of acute scrotal pain

A

Torsion, epididymalorchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Torsion of spermatic cord

A

Enlg hetero and hypo when compared to contralateral testis

Enlg epididymis, skin thickening, reactive hydrocele

Prescience of blood flow does not exclude partial torsion
At least 540 degrees of torsion is necessary to completely occlude testicular blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute epididymitis

A

Enlg Epi, dec echoes, hetero, hydrocele, skin thickening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cryptorchidism / undescended testicle

A

At or below inguinal canal

May cause infertility or cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 complications of undescended testicle

A

Infertility and inc risk of cancer even on the normal testicle with an orchiopexy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Orchiopexy

A

Surgery to move undescended testicle into scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hematocele

A

Blood collection in tunica vaginalis

Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pyocele

A

Pus collection in tunica vaginalis

Infection
Echogenic debri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Endocrine

A

Testosterone (sex hormones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Exocrine

A

Spermatogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Spermatic cord

A

Arteries veins nerves lymphatics vas deferens

Vas deferens connects epididymis to seminal vesicles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Blood supply

A

Testicular artery, cremasteric artery, deferential arteries

Pampiniform plexus-> spermatic vein -> ivc on rt and left renal vein to ivc on left.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sperm travels

A
Epididymis
Vas deferens
Seminal vesicles
Ejaculatory Duct
Urethra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Epididymis

A

Stores sperm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Layers

A

Tunica vaginalis: double sac covering testis, prevents abdomen contents from herniating into sac

Tunica albuginea: fibrous capsule covering testis

Mediastinum: invagination of tunica albuginea. Echogenic line

Appendix testis: fibrous band sup to testis

21
Q

Testis & epididymis meas

A

Testis 3-5 cm L, 2-4 W, 3 AP

Scrotal wall 2-8 mm

Epi head 6-15 mm, body 2-4, tail 2-5 mm

22
Q

Epididymis

A

Head / Globus Major
Body / Corpus
Tail / Globus Minor

Patients with vasectomy, inc size of epi & may see cyst

23
Q

Congenital Anomalies

A

Testicular Ectopia

Anorchia: rare, only 1 testis, vasc problem in utero

Polyorchidism: very rare

24
Q

Rupture

A

Torn capsule, rare, assoc with trauma, early dx & tx critical

Irreg capsule, Hematocele, intratesticular hematoma/infarct, wall thick, absent/dec flow, liquefaction after 3 days

25
Q

Torsion

A

Twisting of testis. “Bell clapper” deformity.
Young males
Resting

Severe sudden pain, when at rest, n/v, radiating pain, may mimic epididymitis.

5-6 hrs can save.

Absent Doppler, inc size, hypo/hetero, skin thickening, hydrocele, necrosis/hemorrhage/infarct

Chronic: small hypo testis, large epi

26
Q

Epididymitis

A

Inflammation of epi.
Bacterial, trauma, idiopathic
Focal or diffuse (head body tail)
Can lead to epididymalorchitis and abscess

Fever, pain urine, tense tender epi/scrotum, Palp hard cord

Skin thickening, hydrocele
Acute: enlg epi, hypo, hypervascular
Chronic: hyper, ca+

27
Q

Spermatocele

A

Retention cyst of sperm containing tubules
MC in epi head

Cystic mass, displace testis ant, septations, indistinguishable from
Epididymal cyst

Spermatocele more common than epididymal cyst & is milky fluid

28
Q

Scrotal hernia

A

Inguinal hernias descended into scrotum.
Assoc with patency of vaginalis and heavy lifting.

Extratesticular mass, bowel, peristalsis unless bowel stuck.

abd pain, blood in stool, constipation

29
Q

Granulomatous Disease

A

TB spread, unilateral, initially involves epi but can spread to testis.

Acute: focal hypo mass
Chronic: blending of epi and testis. Ca+

30
Q

Scrotal Calcifications

A

Benign

Assoc with inflammation, tb, vasc ca+, cryptorchidism, klinefelters, sterility, tumors

31
Q

Microlithiasis

A

Benign
Assoc with infertility, Cryptorchidism, neoplasm

Tiny Echogenic foci, don’t shadow, well disseminated

32
Q

Tunica Albuginea Cyst

A

Rare, 2-5 mm

Cyst ant/lat to testis

33
Q

Epididymal Cyst

A

Dilated epi tubules

Less common than spermatocele. Clear fluid.

34
Q

Testicular cyst

A

Benign

More common in upper pole

35
Q

Epidermoid cyst

A

Benign, germ cell origin

Well defined, Echogenic cyst walls/halo, cystic/hypo, homo, ca+

36
Q

Adenomatoid Tumor

A

Benign Extratesticular
Usually in epi, asymptomatic, uni, left. More common than Leiomyoma

Hypo/hyper, well described, assoc hydrocele

37
Q

Leiomyoma

A

Benign Extratesticular tumor

Less common than adenomatoid tumors

38
Q

Extratesticular malignant neoplasms

A

Fibrosarcoma
Liposarcoma
Rhabdomyosarcoma (peds)

Solid, I’ll defined, hetero, complex with necrosis

39
Q

Intratesticular tumors

A

Most are malignant.

Leydig cell tumor is MC benign but can turn malignant.

40
Q

Benign intratesticular tumors

A
Leydig cell tumor: MC, malignant potential 
Sertoli Tumors
Dermoid cyst
Cystadenomas
Adenomatoid tumors
41
Q

Leydig Cell Tumor / interstitial cell tumor

A

MC non germ cell, benign. Malignant potential.

Endocrine imbalance, impotence (erectile dysfunction), Gynecomastia (inc Breast tissue), dec libido

42
Q

Testicular cancer

A

Young, painless mass, unilateral enlargement. 10% with acute pain

Focal mass, hypo, mixed echoes, hetero, inc vascularity

43
Q

Malignant tumors

A
Seminoma
Embryonal cancer
Choriocarcinoma
Teratoma
Teratocarcinoma
Mets
44
Q

Seminoma

A

MC testicular cancer
30% hx of cryptorchidism
Encapsulated
25% with mets

45
Q

Embryonal Cell Carcinoma

A

Second MC
Aggressive
Cystic necrosis

46
Q

Choriocarcinoma

A

Inc HCG
Mixed echo
Highly malignant
Least common

47
Q

Teratoma

A

Infants & children
Malignant or benign
Ca+

48
Q

Mixed tumors

A

Teratocarcinoma MC
Has teratoma/embryonal cells
Aggressive
Complex mass

49
Q

Mets to testis

A

Rare
Prostate and kidneys MC
Multiple bilateral hypo

50
Q

Lymphoma & Leukemia

A

Infiltration to testis