CH 12 Pediatric Pelvis: Male and Female Flashcards
normal testicle
homogeneous medium echo texture.
Tunica albuginea is the fibrous capsule surrounding the testicle.
Tunica vaginalis is a saccular extension of the peritoneum into the scrotal chambers.
The inner/visceral layer covers the testis and epididymis. The outer/parietal layer lines the scrotal chamber.
Epididymis
parallel to the testicle and is composed of a head, body and tail. It appears as an echogenic curved structure, posteriorlateral to the testes.
Rete testes
massing together of the seminiferous tubules at the testicular hilum (mediastinum testis)
appears hyperechoic in the testicle
Appendix testes
is a remnant of the mullerian duct. Can only be seen in the presence of a hydrocele.
seen as a small oval structure beneath the epididymal head. this structure can undergo torsion.
Testicular artery
arises from the aorta and supplies the testes and epididymis.
Cremasteric artery
arises from the vesical artery and supplies the scrotal wall and extratesticular structures
Deferential artery
supplies the vas deferens and arises from the inferior epigastric artery
Spermatic cord
vas deferens cremasteric, deferential and testicular arteries pampiniform plexus of veins lymphatics nerves
Cryptorchidism
incomplete descent of the testicles.
associated with urological abnomalities 20% of time (look at kidneys)
usually located in inguinal canal proximal to the internal ring.
increased risk of infertility and malignancy.
sono: smaller testis of increased echogenicity are seen anywhere along the path of descent (similar to lymph node)
Anorchidism
bilateral testicular absence
Monorchidism
unilateral testicular absence.
usually left-sided. thought to be due to a vascular accident or in utero torsion
Polyorchidism
more than 2 testes present
Triorchidism
most common form of polyorchidism; small accessory testis within the scrotum in addition to 2 normal testes
Transverse testicular ectopia
both testes are in the same hemiscrotum.
20% have associated anomalies: seminal vesicle cyst, renal dysplasia, hypospadias, UPJ obstruction and an ipsilateral inguinal hernia.
Smaller than normal testes may result with which anomalies:
cryptorchidism torsion inflammation varicocele primary hypopituitarism inguinal hernia repair radiation treatment trauma Klinefelter's syndrome
True Hermaphroditism
intersex condition where the patient has both ovarian and testicular tissue.
sono: textual difference is seen. Testicular tissue is homogeneous and the ovarian tissue is more heterogeneous with cystic follicles seen.
present prepubertal with ambiguous genitalia or postpubertally with amenorrhea in a female raised paitent or cryptorchidim, gynecomastia and cyclic hematuria in a male raised patient.
Cystic dysplasia of the testis
causes painless scrotal enlargement. *rare congenital condition which causes dilatation of the rete testes and efferent ducts and parenchymal atrophy.
may be associated with: ipsilateral renal agenesis, MCDK or renal dysplasia.
Testicular torsion
most common causes of the acute scrotum in pediatric patients.
when testis and spermatic cord twist one or more times cutting off blood flow.
CFD must be used to determine the absence of flow in the painful testis and flow in the normal asymptomatic testis.
*peaks in infancy and adolescence
Extravaginal torsion
torsion is at the level of the spermatic cord and all scrotal contents are strangulated. Occurs in utero, surgical savage at birth not likely due to necrosis. Necrotic testicle must be surgically removed.
may see thickened skin and hydrocele.
compensatory hypertrophy of the contralateral testis.
Intravaginal torsion
within scrotal sac, more commonly in adolescents and young adults. Secondary to lack of normal fixation of the postero/lateral aspect of the testes to the tunica vaginalis.
bell-clapper deformity- testes free to swing and rotate within the tunica vaginalis of scrotum.
present: sudden onset of scrotal/lower abd pain, nause, vomiting. hemiscrotum is red and swollen and the affected testis is often oriented transversely. (40% bilat)
* true medical emergency
Testicular salvage rates:
*aprox 90-100% if surgery within 6 hours of onset of sypmtoms
20-50% within 12-24 hours
0-10% after 24 hours
Testicle salvage rates:
*aprox 90-100% if surgery within 6 hours of onset of sypmtoms
20-50% within 12-24 hours
0-10% after 24 hours
Testicular torsion sono:
normal = early torsion
4-6 hours = enlarged and hypoechoic secondary to edema
after 6 hours= heterogenous, areas of increased echogenicity secondary to vascular congestion, hemorrhage and ischemia.
with any degree of torsion, see abnormal orientation of the testis within the scrotum, abnormally thickened testicular structures, enlarged hypoechoic epididymis, scrotal wall thickening, reactive hydrocele and enlarged twisted spermatic cord.
determine difference between testicular torsion and epididymitis
CFD!
presence of flow does not exclude the diagnosis of torsion. Incomplete or partial torsion may show arterial flow, but it will be diminished as compared to the asymptomatic side.
Bell-and-clapper
detorsion, where the testicle twists back and forth and acute scrotal pain spontaneously resolves, CFD will show increased flow in the testis and the paratesticular soft tissues due to reactive hyperemia.
Torsion of testicular appendages
can result in the clinical presentation of acute scrotum.
appendix testis and appendix epididymis.
Appendix epididymis
remnant of the meonephric (wolffian) duct.
usually projects from the head of the epididymis, location may vary
Appendix epididymis
remnant of the meonephric (wolffian) duct.
usually projects from the head of the epididymis, location may vary
Epididymitis
swelling/inflammation of the tube (epididymis) that connects the testicle with the vas deferens.
Most common in men ages 19-35 and most often caused by the spread of bacterial infection.
Gonorrhea and chlamydia most common in young men, children and older med commonly caused by E coli and similar bacteria.
**with > than 6 week history of symptoms, classic appearance + increased flow within the edematous epididymis.
Epididymitis
swelling/inflammation of the tube (epididymis) that connects the testicle with the vas deferens.
Most common in men ages 19-35 and most often caused by the spread of bacterial infection.
Gonorrhea and chlamydia most common in young men, children and older med commonly caused by E coli and similar bacteria.
with >
Acute epididymitis
2nd most common cause of acuter scrotal pain in children.
more common in pubertal than prepubertal boys
**< 6 weeks and my be due to infection.
hydrocele is usually present with hypervascularity and enlarged epididymis.
associated with lower UTI symptoms and fever.
Orchitis
inflammation of one or both testicles. (male PID)
may be caused by and infection from many different types of bacteria and viruses.
*common virus causing orchitis is mumps, usually develops 4-6 days after mumps begins, testicles may shrink
may occur with infections of the prostate or epididymis or STI’s such as gonorrhea or chlamydia
Hydrocele
serous collection of fluid that accumulates within the tunica vaginalis or surrounds the testes betweent he 2 layers of the tunica vaginalis.
most are congenital and seen in boys ages 1-2.
represent collections of peritoneal fluid that has entered the scrotal sac via a patent processus vaginalis.
most non-communicating hydroceles disappear within a year.
Varicocele
aquired dilation of the veins of the pampiniform plexus.
usually occur after puberty; few may occur from 13-25 yrs
90% on the left due to the length of the left testicular vein as it drains into the LRV. always use CFD, light up.
Epididymal cysts
result from the dilatation of the epididymal tubules, but are composed of clear fluid
due to prior episode of epididymitis
Spermatocele
cystis mass of the epididymis.
dorm due to dilatation of the epidiymal tubules. filled with a milky fluid containing spermatozoa.
due to prior episode of epididymitis
Spermatocele
cystis mass of the epididymis.
dorm due to dilatation of the epidiymal tubules. filled with a milky fluid containing spermatozoa.
due to prior episode of epididymitis
** testicular tumors appear
either the first 2 years of life or postpubertal
Juvenile granulosa
cell tumors are benign cystic tumors.
appear by the age of 6 months in children with ambiguous genitalia
Leydig cell
tumors are rare benign tumor which presents between 5-10 years.
cause precocious puberty and gynecomastia
Seminoma
most common testicular tumor to develop in patients with cryptorchidism; generally malignant.
aprox 30% with a seminoma have h/o undescended testes.
sono: smaller testis of increased echogenicity are senn anywhere along path of descent (similar to lymph node)
Yolk sac tumors (embrynoal cell tumors)
most common malignant germ cell tumors seen in prepubertal children and within undescended testicles.
Female pelvis
always examin urinary tract and lower instestin for abnormalitis when abnomalities of genital tract seen. (20% will have renal anomalies)
Female pelvis
always examin urinary tract and lower instestin for abnormalitis when abnomalities of genital tract seen. (20% will have renal anomalies)