abdomen scrotum and breast reveiw Flashcards
three layers of the breast
located b/w the skin and pectorlias major muscle:
subcutaneous layer, the mammary (glandular layer and the retromammary layer
subcutaneous layer: thin
fatty tisssue
coopers lig
mammary layer:functional part 15-20 lobes rad from nipple laciferous ducts carry milk from acini to the nipple terminal ductl lobular unit (TDLU) is made up of acini and terminal ducts fatty tissue is interspersed bw lobes coopers lig extend from retro fascia to the skin to provide support Retromammary layer: thin fatty tissue coopers lig pect major mucle pectorlis min ribs chest wall
the functional portion of the breast (mammary/glandular layer)consist of how many lobes?
15-20 lobes
fibrous skeleton is responsible for maintaining the shape of the breast?
coopers ligaments!
but..
spaces bw the lobes is filled with connective and fatty tissue known a stroma.
as a women ages gandular breast tissue is replaced with what
tissue undergoes cell death and is remodeled by the infatuating of fatty tissue.
ducts atrophy
fatty breast hard to sono bc breast cancer hypo and so is breast fat
What coopers ligament looks like under ultrasound
coopers lig and other connective tissue appear echogenic and are dispersed in a linear pattern
C.L best identified when the beam strikes them at a perpendicular angle, compression of the breast often enhances the ability to visualize them
Sonographic texture of the retromammary layer:
similar in echogenicity and echotexturre to the subcutaneous lay although the boundary echoes resemble skin reflections . pec major mus appear as low-level echo areas posterior to the retromammay layer. ribs are hyper echoic rounded structures
most important signs that a lesion is cystic
oval or round, anechoic, imperceptible capsule, posterior or acoustic enhancement, edge refraction shadowing, often compressible
if patient has clinicals signs of lumpy, bumpy, tender breast with their monthy cycle, what kind of breast disease do they have?
fibrocystic condition( fibrocystic change/ fibrocystic disese)
lumps and pain that patient feels that fluctuate with every monthly cycle. usually both breast.
sono: round masses as multiple cysts.
What are the characteristic of a papilloma
intraductal papilloma is small, benign tumor that grows within the acini.
age 35-55
symptom:
nipple discharge from a single duct
sensation of fullness or pain in the areola that is relieved by fluid being expelled
mamo” raspberry like
sono: usually small, muli and multicentric. supported by a vasular stalk from which it receves blood
- arise from lining of breast ducts, retroareolar area most common
Bloody discharge from single duct
Sonographic findings
Tiny papilloma may not be detected
May cause dilatation of a single duct
Intracystic papillomas- soft tissue mass growing into lumen of cystic lesion
most common solid benign tumor of the breast?
benign fibroadenoma
sono:
oval or gentaly lobular, hypoechogenic, uniform echogenicity, smooth, distinct margins, wider than tall, posterior acoustic enhancement, edge refraction shadow
stimulated by estrogen
firm, rubbery, freely mobile and clearly delineate from the surrounding tissue
lymphatic drainage where?
lymphatic drainage from all parts of the breast generally flows to the axillary lymph nodes
from superfical to deep nodes of the breast centrifugally toward the axillary and interal lymph node chains only 3% eliminated by the interal and 97% by axillary chain
most common malignant neoplasam of the breast?
Invasive ductal carcinoma-IDC
Extension past duct and into stroma
Most common malignancy
Hard fixed mass
Skin dimpling or skin/nipple retraction
Mammography findings: Asymmetric Radiopaque speculated mass Microcalcifications Thickened and retracted Cooper’s ligament
Sonographic findings: Solid mass Hypoechoic Heterogeneous Taller than wide orientation Distal acoustic shadowing Possible- microlobulations, microcalcification, ductal extension branch pattern, fascial plane disruption
describe the characteristics of breast carcinoma
margins: indistinct, fuzzy, spiculated
architecture: grow through tissue without compression of the tissue adjacent to the mass
may cause retraction of nipple or skin dimpling
shape: sharp, angular microlobulations > or =3
taller than wide, radial growth suspicious,
echo: hyperechoic, weak internal echoes, clustered microcalcifications.
strong attenuating
firmly fixed
rigid, noncompressible
hypervscular, feeder
ves.ssels
skin dimpling suggestive of what?
Invasive ductal carcinoma-IDC
Papillary
most common clinical sign of breast cancer?
70% of cancers found as lumps felt during Beast self-exam or clinical breast exam
Primary purpose of breast screening?
?
know your clock.
.
normal extension of breast tissue into the axillary region.
tail of spence
according to the american cancer society all women should begin annual mammogram screening at what age?
40
which one of the following arteries is responsible for supplying blood to more than 1/2 of the breast?
more than 1/2 of breast (mainly central and medial part) supplied by the anterior perforating branches of the internal mammary artery
remaining portion (upper outer quad) supplied by the lateral thoracic artery
condition where a male has breast?
gynecomastia
know which breast procedure use ultrasound for guidance.
- Cyst aspirations
- fine-needle aspiration cytology (FNAC), abscess or seroma drainage
- Large-core needle biopsy(for tissue diagnosis
- Needle localization-
If pregnant or young patient what modality is best?
us
what other modalities besides Ultrasound is used for the breast?
mammography- sensitive method of screening
US and MRI- provide additional characterization and further interrogation of breast lesions
if you see a smooth mass on a mammogram, and order sono images, what will you see?
cyst?
advantages of breast us over mamo?
us can better visualize young, dense breasts, to visualize palpble mass not visualized on mammo and to image the deep juxathoracic tissue not visualized by mammo. us can diff solid, round masses from fluid filled cyst and for tissue adjacent to implants
what is the diameter of a varicocele?
> 2mm in diameter and increase in size in response to valsalva maneuver
ARE CAUSE BY AN ABNORMAL DILATION OF THE VEINS OF THE PAMPINIFORM PLEXUS ARE CAUSED BY INCOMPETENT VALVES WITHIN THE SPERMATIC VEIN MORE COMMON ON LEFT DUE TO LSV EMPTING INTO LRV AT A STEEP ANGLESECONDARY VARICOCELES ARE MORE COMMON IN MEN OVER 40 AND ARE THE RESULT OF RENAL HYDRO, ABD MASS OR LIVER CIRRHOSIS (as the result of portal hypertension)
Whats the fibrous capsule surrounding the testicle?
tunica albuginea
normal measurement of the testicles?
testicles-3 to 5cm length
2 to 4 cm width
3 cm height
epididymis 6-7 cm tubular structure
head of epididymis 6-15mm
sonographic characteristics of a testicle?
smooth, medium gray structures with a fine echo texture
linear echogenic strip that runs through testicle
B. The posterior aspect of the tunica albuginea reflects into the testis to form a vertical septum known as the mediastinum testis
normal location of the epididymis?
begins superiorly and then courses posterolateral to the testis
facts about undesended testies
C. The undescended testes may be located in the abdomen, inguinal canal, or other ectopic location
D. In most cases (up to 80%) the testis is found in the inguinal canal and is usually palpable
E. This condition is more common in premature babies
F. This is a bilateral condition 10 to 25% of cases
G. Surgical treatment is known as orchiopexy, if not performed at an early age multiple complications occur
H. Undescended testis are more likely to develop into cancer
I. Testicular torsion is also more common in undescended testis
E. Undescended testes are 2.5 to 8 times more likely to develop cancer
most common cause of acute scrotal pain in an adolescent?
O. Torsion is the most common cause of acute scrotal pain in adolescents
P. Torsion can occur at any age with peak at age 14
Q. Sudden onset of scrotal pain accompanied by swelling on the affected side
R. The severe scrotal pain causes nausea and vomiting
S. Sonographically, the testes become swollen and hypoechoic
T. After 24 hours, the testis becomes heterogeneous because of hemorrhage , infarction, necrosis and vascular congestion
U. Absence of normal perfusion on color Doppler
common causes for hydroceles?
commonly with epididymo-orchitis and torsion.
A potential space exists between the visceral, abnormal accumulation of serous fluid in tunica vaginalis
b) Most common cause of painless scrotal swelling
c) Hydroceles associated with neoplasms tend to be smaller
d) A small amount may exist normally
e) Congenital or idiopathic
f) Usually due to epididymitis
g) May be seen with orchitis, spermatic cord torsion, and trauma
know about varicoceles
B. A varicocele is an abnormal dilatation of the veins of the pampiniform plexus (located within the spermatic cord)
C. Varicoceles are usually caused by incompetent valves within spermatic vein, these are called primary varicoceles
D. These are more common on the left
E. Secondary varicoceles are caused by increased pressure on the spermatic vein- may be a result of renal hydronephrosis, abdominal mass , or liver cirrhosis
F. An abnormal malignancy invading the left renal vein may cause a varicocele with noncompressable veins
G. Any noncompressable varicocele in a man more than 40 years of age should prompt a search for retroperitoneal mass
H. Varicoceles have a relationship with impaired fertility
I. More common in infertile men
J. Valsalva maneuver will demonstrate color flow
where is a spermatocele located?
- Spermatoceles are cystic dilatation of the efferent ductules of the epididymis- they are always located in the epididymal head
- Spermatoceles contain proteinaceous fluid and spermatozoa
- They may be seen more often after vasectomy
- Epididymal cysts are small, clear cysts containing serous fluid
- All three of these are asymptomatic, may be palpable
common cause of scrotal pain in adults?
Epididymo-Orchitis ( most common in adults)
C. Infection of the epididymis and testis
D. Most commonly results from the spread of a lower urinary tract infection via the spermatic cord
E. Epididymitis spreads to the testis in about 20 to 40% of cases
F. Abscess may occur if untreated
almost always transpires secondary to epididymitis?
scrotal wall thinening and hydrocele in sever cases pyocele
hyperemic flow
7) Decreased echogenicity with heterogeneous coarse echo pattern
8) May be associated with hydrocele
9) Increased Doppler flow in affected region when compared to contralateral side
3) Clinical findings- fever, dysuria, may have urethral discharge
4) Sonographic findings
tubular ectasia
associated with presence of spermatocele an epididymal or testicular cyst or other epididymal obssruction on the same side as the dilated tubules
This is an uncommon, benign condition
B. More commonly seen in men 45 years or older
what is a seminoma? sono?
most common type of germ cell tumor,
hypoechoic, smooth well defined borders
epididymo-orchidis most commonly from what?
Most commonly results from the spread of a lower urinary tract infection via the spermatic cord
clinical history of a vasectomy associated with what?
- Spermatoceles contain proteinaceous fluid and spermatozoa
- They may be seen more often after vasectomy
primary source of blood supply to the testicle?
A. Right and left testicular arteries arise from the abdominal aorta just below the level of the renal arteries- these are the primary source of blood flow to the testis
B. The testicular arteries descend in the retroperitoneum and enter the spermatic cord in the deep inguinal ring
testicular a > capsular a > centripetal artery > recurrent rami
intratesticular cyst have an association with what?
common in men over 40 and associated with extratesticular spermatoceles
multi or single
near the mediastinum
Microlithiasis is associated with what?
testicular malignancy
A. Uncommon condition characterized by tiny calcifications within the testis
B. These calcifications are smaller than 3 mm and usually bilatateral
C. Microlithiasis also has been associated with cryptochidism, Klinefelter syndrome, infertility, varicoceles, testicular atrophy and male pseudohermaphroditism
follow up of microlithiasis is recommended how frequently?
annually
attached at the superior pole of the testi b/w the epididymis head and teste, is what structure?
Appendix Testis
At the upper pole of the testis, the appendix testis is attached
It is located between the testis and the epididymis
Postmortem studies have shown the appendix testis to be present in 92% of testes unilaterally and 69% bilaterally
a hydrocele developes between what layers?
visceral and parietal layers of the tunica vaginalis
location of the rete teste?
at the hilum of the testis where the mediastinum resides
sonographic appearance difference of testicle to epididymis?
L. The normal epididymis usually appears as isoechoic or hypoechoic compared with the testis, although the echo texture is coarser
