1.2 Benign Scrotal Pathologies Flashcards
Most Extratesticular masses (within scrotum)
Benign
Intratesticular masses (inside testicular tissue)
Malignant
What is a congenital anomaly where the testes are undescended.
*Hint: most common GU abnormality in children
Cryptorchidism (benign)
Where is the majority of Cryptorchidism located?
inguinal canal and palpable (80%)
Is Cryptorchidism usually bilateral or unilateral?
Unilateral
What is the structure that guides and anchors the testes during decent into the scrotal sac?
Gubernaculum
What 3 factors can interrupt the decent of the testes
- Deficiency of Gonadotropin hormone in pregnancy
- Adhesions or anatomic mal-developments that block decent into scrotal sac
- idiopathic
Complication of undescended testes (2)
- Infertility
2. Testicular cancer (48x)
Treatment of undescended testes in children
Orchiopexy
before age 2 fertility okay!
Treatment of undescended testes in adults
Orchiectomy
Undescended testes sonographically look like?
Oval or elongated mass, smaller, less echogenic, homogenous
What will be hard to identify in the Undescended testes
Mediastinum
What is commonly mistaken for the testicle with Undescended teste?
Lymph node (inguinal lymph node)
What are 3 other congenital anomalies (rare)?
- Polyochidism
- Anorchia
- Testicular Ectopia
Polyochidism means?
Testicular duplication (extra testicle)
Anorchia means?
Abcence of a testicle (more common on left)
Testicular Ectopia means?
Normal R + L Testicle with additional tissue located else where in the body.
What is a hydrocele? (benign)
Fluid located between the tunica vaginalis layers
What does the fluid have to measure to be classified as a hydrocele?
> 2mm
Where are most hydroceles located?
In the Anterolateral scrotum
What is the most common sign/symptom of hydrocele
PAINLESS SCROTAL SWELLING
Hydrocele can be either ____ or ____
Congenital
or
Acquired
What is a congenital hydrocele?
Patent processus vaginalis
usually resolves by 18 months
What is a acquired hydrocele?
Idiopathic (most)
infection, infarction or
trauma (25%)
Small hydroceles are seen in ___ % of patients with testicular tumors.
60%
Are large hydroceles associated with neoplasms? yes or no?
NO
The sonographic appearance of hydrocele ?
variable anechoic septations calcs "scrotal pearls" debris
Hematocele is ?
blood in the scrotal sac
thick scrotal wall, Anechoic, septations, debris, variable appearance
Pyocele is?
Pus in the scrotal wall
absess that burst
thick scrotal wall, Echogenic, variable appearance, possible mural calcifications
What is a varicocele
Dilated veins in the pampiniform plexus
due to obstruct venous return
What does the vein have to measure to be classified as a varicocele?
> 2 mm
What side are varicoceles typically on?
Left
Varicocele can be either ___ or ___ in origin
Primary
or
Secondary
What is a primary varicocele?
Age & cause
15-25 years of age
common cause of correctable infertility
incompetent valves in spermatic vein
What is a secondary varicocele?
Pressure on spermatic vein
usually from mass causing extrinsic pressure
Another cause of varicocele? (not in notes)
RCC spreads from kidney to LRV and obstructs drainage of left testicular vein also leads to varicocele
What is the “nut cracker syndrome”
Compression of LRV between aorta and SMA
What maneuver should you have the patient do is suspect varicocele?
Valsalva or Stand
What should happens in a patient with a primary varicocele when Valsalva or Stand?
The vessel should increase in size with valsalva or when stands and return to normal size when stops.
What should happens in a patient with a secondary varicocele when Valsalva or Stand?
The vessel has no affect. bc it is due to a mass
What is the sonographic feature of a varicocele?
Multiple anechoic structures >2mm
Normally surrounding testicle
What will a varicocele look like with color
with Valsalva ?
color flow increase
What are scrotal Herinas? and what do they contain?
Inguinal hernias that descend into the scrotum usually containing omentum or bowel (look for peristalsis)
How do these scrotal herinas usually happen?
Heavy lifting
What are signs & symptoms of scrotal herinas (3)
Scrotal enlargement, pain, blood in stool
What can trauma of the testicle result in (2)
- Hematoma
2. Hematocele
A ruptured testicle is an emergency and is when the ____ tears
Tunica albugina tears
What is Torsion
Spermatic cord twists, cut off blood supply to testicle
What age is torsion common?
<25 years of age
Surgery to salvage the testicle should happen within ___ hours. Complete infarction will happen after __ hours
6; 12
what are the 3 stages of torsion and how many days associated with each?
- Acute - within 24 hours
- Subacute 1 - 10 days after torsion
- Chronic after 10 days
What are the are 2 types of torsion?
- Intravaginal (more common) often during puberty
2. Extravaginal
What is Intravaginal torsion?
Anomalous suspension of teste by long stalk of spermatic cord (long cord)
Intravaginal torsion the testes rotate freely within the tunica vaginalis this is known as the ______ deformity
“Bell clapper” deformity
When is there an increased incidence of intravaginal torsion?
After orchiopexy
surgery to fix an undescended testicle
What is extravaginal torsion?
Poor/absent attachment of testis to scrotal wall
Both the tunica vaginalis & spermatic cord twist (torsion)
What age is extravaginal torsion more common?
Newborns
Intra and Extravaginal torsion both look the same sonographically. T or F
True
Stages of the Torsion look sonographically different T or F
True
Acute Torsion songraphically (5)
- Enlarged Testicle and epididymis
- Testes hypoechoic
- Thick scrotal skin
- Reactive hydrocele
- Absent arterial flow
Subacute Torsion songraphically (2)
- Enlarged Testicle and epididymis
2. HETEROGENOUS
Chronic Torsion songraphically (2)
- Testicle will Atrophy (decrease in size)
- Heterogenous
- Enlarged epididymis
Signs and Symptoms of Torsion
Sudden onset of extreme pain
N & V
Symptoms of Torsion may mimic ____ but diminish after __to___ days
Epididymitis but diminish after 1-2 days
bc becomes necrotic nerves die
Where does infection in the testicles originate from
- bladder
- urethra
- prostate
Where is the most common place for infection to originate from ?
The urethra
The most common cause of ACUTE scrotal pain in adults is?
Epididymitis
typically Unilateral
What are the S & S of Epididymitis? (4)
- Fever
- Pain
- Dysuria
- Discharge
The sonographic appearance of Epididymitis? (7)
- Enlarged Epi
- Hypoechoic/ Heterogenous
- Scrtoal thickening
- Hydrocele?
- Increase blood flow to epi
- abscess?
- **with Chronic possible calcs
What is Orchitis?
Inflammation of the testies
What is Orchitis secondary to ?
Epididymitis
The most common cause of orchitis in men <35 is?
Chlamydia
Focal Orchitis is described as?
Hypo, mass like, Hypervascular
sounds like cancer so Doc relies on S&S, it they have the m, probably not cancer
Diffuse Orchitis is described as?
Decrease in echogenicity, enlarged
Chronic Orchitis is described as?
Hypoechoic, heterogenous, may have reactive hydrocele
What is an Abscess?
collection of fluid and debris
can rupture thru tunica vaginalis
What can a Abscess cause
Pyocele or fistula to skin
What is the sonographic appearance of an Abscess?
anechoic or complex mass with increased flow in the periphery
What are Scrotal pearls?
Calcifications on Tunica or within scrotal sac (OUTSIDE TESTICLE IN SCROTAL SAC)
unknown etiology, MOBILE
What is a spermatocele?
Retention cyst. Dilated epididymal tubules filled with non viable sperm
What are spermatocele caused by? (2)
Trauma/surgery(vascectomy) or epididymitis
Where are spermatocele commonly located?
Epi head
Who are spermatocele common in?
Middle aged men.
Signs and symptoms of spermatocele
Painless mass, single/multiple/palpable
What is the sonographic appearance of spermatocele
Anechoic, well defined, mass, posterior enhancement, cystic structures (simple or septations) may have debris
What is the rang of size a spermatocele can be?
0.2-9 cm
What are true cysts?
cysts we are born with. Can occur anywhere. Cant differentiate between true cysts and spermatocele
What is more common to be seen in the epididymis a true cyst or a spermatocele?
Spermatocele
Non-Germ cell Tumors are also known as?
Gonadal stromal
The majority of Non-Germ cell Tumors are Benign or Malignant?
Benign
Non-Germ cell Tumors affect ages __ to __
20-50 years of age
Non-Germ cell Tumors are made of what 2 types of cells?
Leydig
Steroli
Leydig cells may cause?
gynecomastia (breasts in men)
Steroli cells may cause?
gynecomastia (breasts in men) and feminization (small testicles)
Non-Germ cell Tumors Sonographically?
small, well defined, hypoechoic
WHAT IS THE MOST COMMON EXTRATESTICULAR TUMOR? (outside teste tissue)
Adenomatoid Tumor
Adenomatoid Tumor typically grow in the ?
Epididymis
Adenomatoid Tumor are described as? (3)
Slow growing - Benign
asymptomatic
small
Adenomatoid Tumor Sonographically (5)
Well defined variable echogenicity solid unilateral typical on left side
What is Microlitiasis?
Calcifications within the seminiferous tubules
multiple tiny echogenic foci
Microlitiasis is ______ testicular tissue where Scrotal pearls are _____ testicular tissue in scrotal sac
inside;outside
Microlitiasis <5 per transducer field
Benign, incidental finding
Microlitiasis >5 per transducer field
Possible malignancy- need to be screen every 6 months