Gyne activity questions 7 - 10

Question 1

can the identification of the testes during an 18-20 week fetal scan be used reliably for gender determination?

Answer 1

No. However a penis and scrotum will be present.

the testicular descent into the scrotum occurs well after 20 weeks gestation.

Question 2

Testicular descent occurs in combination with….

Answer 2

the enlargement of the testes, atrophy of the mesonephric kidneys and paramesonephric ducts.

Question 3

At 26 weeks where have the testes descended to?

Answer 3

the posterior inguinal rings

The next stage is the journey through the inguinal canal

Question 4

What is the process of testicular descent controlled by?

Answer 4

androgens and increasing intraabdominal pressure.

Question 5

How long does it take the testes to pass through the inguinal canal and into the scrotum?

Answer 5

This takes two to three days as the testes pass external to the peritoneum and processus vaginalis.

Question 6

What happens to the canal once the testes pass through the canal?

Answer 6

In most fetuses, the canal then contracts.

Question 7

At what fetal age does the testis descend down the inguinal canal?

Answer 7

36 weeks

Question 8

What is the increased incidence of malignant change in an undescended testis?

Answer 8

48 times

Question 9

In what ways will an undescended testis vary on ultrasound from a typically located testis?

Answer 9

Smaller and more hypoechoic

Question 10

What happens to the pars infravaginalis gubenaculi (PIG) and the gubernaculum after testicular descent?

Answer 10

Both of these structure atrophy and thus are not evident on ultrasound

Question 11

What is the sensitivity of ultrasound in detecting an undescended testis?

Answer 11

70-91% sensitivity. MRI is able to improve on this percentage.

Question 12

What are the two layers of tunica vaginalis?

Answer 12

Visceral and parietal

Question 13

Is fluid between the tunica vaginalis normal?

Answer 13

In small amount, yes.

Large amounts are called a hydrocele

Question 14

How does a hydrocele impact upon the testis?

Answer 14

The important thing to note is that a hydrocele does not distort the shape of the testis but surrounds it.

Question 15

If a collection of fluid compressed the testis, what is it likely to be?

Answer 15

A collection of fluid that distorts or compresses the testis is likely to be a large epididymal cyst.

Question 16

What causes a congenital hydrocele?

Answer 16

persistence of a communication between the peritoneal cavity and the tunica vaginalis through a patent processus vaginalis.

Question 17

What causes an acquired hydrocele?

Answer 17

may occur at any age
due to a number of pathological conditions.
Examples include: inflammation of the tunica vaginalis and injury/inflammation of the epididymis.

Question 18

What are the clinical similarities and differences between orchitis and tortion?

Answer 18

The torsion heads off to theatre urgently to get the vascularity back into the testis.
The orchitis will require antibiotics and have an excellent outcome. Surgery is not required.
In this context, it is a very difficult diagnosis and thus ultrasound is used as the primary imaging modality. Both have pain !

Question 19

What are the similarity and differences in b mode ultrasound appearances of orchitis and tortion?

Answer 19

In both orchitis and torsion, the testis can undergo similar change.
The testis becomes slightly oedematous and thus becomes slightly hypoechoic and heterogenous.
There can be prominent vessels in both.
In the case of torsion, these will be congested veins becoming prominent
in orchitis, this will be an increase in calibre due to hyperaemia.

Question 20

What are the similarity and differences in colour ultrasound appearances of orchitis and tortion?

Answer 20

Distinctly different. The orchitis will show a flood of vascularity, greater than the contralateral side. The torsion will show no vascularity.

Question 21

What are the similarity and differences in epididymis ultrasound appearances of orchitis and tortion?

Answer 21

In epididymo-orchitis, the epididymis becomes enlarged and hyperaemic. There is significant focal tenderness.
In torsion, there is often no change to the appearance of the epididymis.

Question 22

What are the similarity and differences in hemiscrotum ultrasound appearances of orchitis and tortion?

Answer 22

Both pathologies may have a reactive hydrocele and thus this is not discriminatory.