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ABDOMEN 4 > 1.2 Benign Scrotal Pathologies > Flashcards

1.2 Benign Scrotal Pathologies Flashcards

1
Q

Most Extratesticular masses (within scrotum)

A

Benign

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2
Q

Intratesticular masses (inside testicular tissue)

A

Malignant

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3
Q

What is a congenital anomaly where the testes are undescended.
*Hint: most common GU abnormality in children

A

Cryptorchidism (benign)

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4
Q

Where is the majority of Cryptorchidism located?

A

inguinal canal and palpable (80%)

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5
Q

Is Cryptorchidism usually bilateral or unilateral?

A

Unilateral

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6
Q

What is the structure that guides and anchors the testes during decent into the scrotal sac?

A

Gubernaculum

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7
Q

What 3 factors can interrupt the decent of the testes

A
  1. Deficiency of Gonadotropin hormone in pregnancy
  2. Adhesions or anatomic mal-developments that block decent into scrotal sac
  3. idiopathic
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8
Q

Complication of undescended testes (2)

A
  1. Infertility

2. Testicular cancer (48x)

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9
Q

Treatment of undescended testes in children

A

Orchiopexy

before age 2 fertility okay!

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10
Q

Treatment of undescended testes in adults

A

Orchiectomy

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11
Q

Undescended testes sonographically look like?

A

Oval or elongated mass, smaller, less echogenic, homogenous

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12
Q

What will be hard to identify in the Undescended testes

A

Mediastinum

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13
Q

What is commonly mistaken for the testicle with Undescended teste?

A

Lymph node (inguinal lymph node)

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14
Q

What are 3 other congenital anomalies (rare)?

A
  1. Polyochidism
  2. Anorchia
  3. Testicular Ectopia
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15
Q

Polyochidism means?

A

Testicular duplication (extra testicle)

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16
Q

Anorchia means?

A

Abcence of a testicle (more common on left)

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17
Q

Testicular Ectopia means?

A

Normal R + L Testicle with additional tissue located else where in the body.

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18
Q

What is a hydrocele? (benign)

A

Fluid located between the tunica vaginalis layers

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19
Q

What does the fluid have to measure to be classified as a hydrocele?

A

> 2mm

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20
Q

Where are most hydroceles located?

A

In the Anterolateral scrotum

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21
Q

What is the most common sign/symptom of hydrocele

A

PAINLESS SCROTAL SWELLING

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22
Q

Hydrocele can be either ____ or ____

A

Congenital
or
Acquired

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23
Q

What is a congenital hydrocele?

A

Patent processus vaginalis

usually resolves by 18 months

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24
Q

What is a acquired hydrocele?

A

Idiopathic (most)
infection, infarction or
trauma (25%)

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25
Q

Small hydroceles are seen in ___ % of patients with testicular tumors.

A

60%

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26
Q

Are large hydroceles associated with neoplasms? yes or no?

A

NO

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27
Q

The sonographic appearance of hydrocele ?

A 
variable
anechoic
septations
calcs "scrotal pearls"
debris
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28
Q

Hematocele is ?

A

blood in the scrotal sac

thick scrotal wall, Anechoic, septations, debris, variable appearance

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29
Q

Pyocele is?

A

Pus in the scrotal wall

absess that burst
thick scrotal wall, Echogenic, variable appearance, possible mural calcifications

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30
Q

What is a varicocele

A

Dilated veins in the pampiniform plexus

due to obstruct venous return

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31
Q

What does the vein have to measure to be classified as a varicocele?

A

> 2 mm

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32
Q

What side are varicoceles typically on?

A

Left

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33
Q

Varicocele can be either ___ or ___ in origin

A

Primary
or
Secondary

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34
Q

What is a primary varicocele?

Age & cause

A

15-25 years of age
common cause of correctable infertility
incompetent valves in spermatic vein

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35
Q

What is a secondary varicocele?

A

Pressure on spermatic vein

usually from mass causing extrinsic pressure

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36
Q

Another cause of varicocele? (not in notes)

A

RCC spreads from kidney to LRV and obstructs drainage of left testicular vein also leads to varicocele

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37
Q

What is the “nut cracker syndrome”

A

Compression of LRV between aorta and SMA

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38
Q

What maneuver should you have the patient do is suspect varicocele?

A

Valsalva or Stand

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39
Q

What should happens in a patient with a primary varicocele when Valsalva or Stand?

A

The vessel should increase in size with valsalva or when stands and return to normal size when stops.

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40
Q

What should happens in a patient with a secondary varicocele when Valsalva or Stand?

A

The vessel has no affect. bc it is due to a mass

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41
Q

What is the sonographic feature of a varicocele?

A

Multiple anechoic structures >2mm

Normally surrounding testicle

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42
Q

What will a varicocele look like with color

with Valsalva ?

A

color flow increase

43
Q

What are scrotal Herinas? and what do they contain?

A

Inguinal hernias that descend into the scrotum usually containing omentum or bowel (look for peristalsis)

44
Q

How do these scrotal herinas usually happen?

A

Heavy lifting

45
Q

What are signs & symptoms of scrotal herinas (3)

A

Scrotal enlargement, pain, blood in stool

46
Q

What can trauma of the testicle result in (2)

A
  1. Hematoma

2. Hematocele

47
Q

A ruptured testicle is an emergency and is when the ____ tears

A

Tunica albugina tears

48
Q

What is Torsion

A

Spermatic cord twists, cut off blood supply to testicle

49
Q

What age is torsion common?

A

<25 years of age

50
Q

Surgery to salvage the testicle should happen within ___ hours. Complete infarction will happen after __ hours

A

6; 12

51
Q

what are the 3 stages of torsion and how many days associated with each?

A
  1. Acute - within 24 hours
  2. Subacute 1 - 10 days after torsion
  3. Chronic after 10 days
52
Q

What are the are 2 types of torsion?

A
  1. Intravaginal (more common) often during puberty

2. Extravaginal

53
Q

What is Intravaginal torsion?

A

Anomalous suspension of teste by long stalk of spermatic cord (long cord)

54
Q

Intravaginal torsion the testes rotate freely within the tunica vaginalis this is known as the ______ deformity

A

“Bell clapper” deformity

55
Q

When is there an increased incidence of intravaginal torsion?

A

After orchiopexy

surgery to fix an undescended testicle

56
Q

What is extravaginal torsion?

A

Poor/absent attachment of testis to scrotal wall

Both the tunica vaginalis & spermatic cord twist (torsion)

57
Q

What age is extravaginal torsion more common?

A

Newborns

58
Q

Intra and Extravaginal torsion both look the same sonographically. T or F

A

True

59
Q

Stages of the Torsion look sonographically different T or F

A

True

60
Q

Acute Torsion songraphically (5)

A
  1. Enlarged Testicle and epididymis
  2. Testes hypoechoic
  3. Thick scrotal skin
  4. Reactive hydrocele
  5. Absent arterial flow
61
Q

Subacute Torsion songraphically (2)

A
  1. Enlarged Testicle and epididymis

2. HETEROGENOUS

62
Q

Chronic Torsion songraphically (2)

A
  1. Testicle will Atrophy (decrease in size)
  2. Heterogenous
  3. Enlarged epididymis
63
Q

Signs and Symptoms of Torsion

A

Sudden onset of extreme pain

N & V

64
Q

Symptoms of Torsion may mimic ____ but diminish after __to___ days

A

Epididymitis but diminish after 1-2 days

bc becomes necrotic nerves die

65
Q

Where does infection in the testicles originate from

A
  1. bladder
  2. urethra
  3. prostate
66
Q

Where is the most common place for infection to originate from ?

A

The urethra

67
Q

The most common cause of ACUTE scrotal pain in adults is?

A

Epididymitis

typically Unilateral

68
Q

What are the S & S of Epididymitis? (4)

A
  1. Fever
  2. Pain
  3. Dysuria
  4. Discharge
69
Q

The sonographic appearance of Epididymitis? (7)

A
  1. Enlarged Epi
  2. Hypoechoic/ Heterogenous
  3. Scrtoal thickening
  4. Hydrocele?
  5. Increase blood flow to epi
  6. abscess?
  7. **with Chronic possible calcs
70
Q

What is Orchitis?

A

Inflammation of the testies

71
Q

What is Orchitis secondary to ?

A

Epididymitis

72
Q

The most common cause of orchitis in men <35 is?

A

Chlamydia

73
Q

Focal Orchitis is described as?

A

Hypo, mass like, Hypervascular

sounds like cancer so Doc relies on S&S, it they have the m, probably not cancer

74
Q

Diffuse Orchitis is described as?

A

Decrease in echogenicity, enlarged

75
Q

Chronic Orchitis is described as?

A

Hypoechoic, heterogenous, may have reactive hydrocele

76
Q

What is an Abscess?

A

collection of fluid and debris

can rupture thru tunica vaginalis

77
Q

What can a Abscess cause

A

Pyocele or fistula to skin

78
Q

What is the sonographic appearance of an Abscess?

A

anechoic or complex mass with increased flow in the periphery

79
Q

What are Scrotal pearls?

A

Calcifications on Tunica or within scrotal sac (OUTSIDE TESTICLE IN SCROTAL SAC)
unknown etiology, MOBILE

80
Q

What is a spermatocele?

A

Retention cyst. Dilated epididymal tubules filled with non viable sperm

81
Q

What are spermatocele caused by? (2)

A

Trauma/surgery(vascectomy) or epididymitis

82
Q

Where are spermatocele commonly located?

A

Epi head

83
Q

Who are spermatocele common in?

A

Middle aged men.

84
Q

Signs and symptoms of spermatocele

A

Painless mass, single/multiple/palpable

85
Q

What is the sonographic appearance of spermatocele

A

Anechoic, well defined, mass, posterior enhancement, cystic structures (simple or septations) may have debris

86
Q

What is the rang of size a spermatocele can be?

A

0.2-9 cm

87
Q

What are true cysts?

A

cysts we are born with. Can occur anywhere. Cant differentiate between true cysts and spermatocele

88
Q

What is more common to be seen in the epididymis a true cyst or a spermatocele?

A

Spermatocele

89
Q

Non-Germ cell Tumors are also known as?

A

Gonadal stromal

90
Q

The majority of Non-Germ cell Tumors are Benign or Malignant?

A

Benign

91
Q

Non-Germ cell Tumors affect ages __ to __

A

20-50 years of age

92
Q

Non-Germ cell Tumors are made of what 2 types of cells?

A

Leydig

Steroli

93
Q

Leydig cells may cause?

A

gynecomastia (breasts in men)

94
Q

Steroli cells may cause?

A

gynecomastia (breasts in men) and feminization (small testicles)

95
Q

Non-Germ cell Tumors Sonographically?

A

small, well defined, hypoechoic

96
Q

WHAT IS THE MOST COMMON EXTRATESTICULAR TUMOR? (outside teste tissue)

A

Adenomatoid Tumor

97
Q

Adenomatoid Tumor typically grow in the ?

A

Epididymis

98
Q

Adenomatoid Tumor are described as? (3)

A

Slow growing - Benign
asymptomatic
small

99
Q

Adenomatoid Tumor Sonographically (5)

A 
Well defined
variable echogenicity
solid
unilateral
typical on left side
100
Q

What is Microlitiasis?

A

Calcifications within the seminiferous tubules

multiple tiny echogenic foci

101
Q

Microlitiasis is ______ testicular tissue where Scrotal pearls are _____ testicular tissue in scrotal sac

A

inside;outside

102
Q

Microlitiasis <5 per transducer field

A

Benign, incidental finding

103
Q

Microlitiasis >5 per transducer field

A

Possible malignancy- need to be screen every 6 months

ABDOMEN 4 (10 decks)

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