Imaging Flashcards
1
Q
What are the two modalities most commonly used for scrotal imaging?
A
- Ultrasonography (US)
- Magnetic Resonance Imaging (MRI or MR)
- Not used as often compared to ultrasound
- May be used for more complicated cases
2
Q
What is the differential for painless scrotal swelling?
A
- Hydrocele, may be reactive
- Varicocele, usually left side, bag of worms
- Testicular mass – occasionally mild discomfort
- Solid – usually malignant
- Germ cell tumor, males 18 – 40 year old
- Metastasis (leukemia, lymphoma, melanoma, GU tract)
- Cyst – if simple, usually benign
- Solid – usually malignant
- Extratesticular mass – usually benign
- Cyst: Spermatocele or epididymal cyst
- Solid: lipoma, adenomatoid tumor, inguinal hernia
3
Q
What is the differential for painful scrotal swelling?
A
- Epididymitis + orchitis, assoc UTI or prostatitis
- Torsion – sudden onset of pain
- Post-pubertal and neonatal age group
- Testis high riding, transverse orientation
- Surgical emergency
- Trauma
- Hematocele
- Testicular hematoma and/or rupture
- Surgical emergency if rupture
- Inguinal hernia – particularly if incarcerated
4
Q
What is a hydrocele and what are the findings on imaging?
A
- Accumulation of serous fluid within tunica vaginalis
- Small volume is normal
- Etiology: infection, trauma, tumor, idiopathic, rarely congenital
- Usually anechoic
- Occasionally contains low-level echoes and fibrin strands
- Unclear if treatment helps fertility, and treatment may injure epididymis
5
Q
What are the major findings of varicocele on imaging?
A
Large collection of vessels that show blood flowing away on imaging
6
Q
What are the findings of testicular torsion on imaging?
A
- Longitudinal US scan of the right hemiscrotum shows a round supratesticular mass, which represents an edematous spermatic cord
- There are several anechoic structures (arrowheads) within the mass, which probably represent obstructed and dilated lymphatic vessels.
- Bilateral transverse color Doppler images show no color flow signals in the right testis, which is enlarged and has heterogeneous echogenicity
- Reactive hydrocele and thickening of the scrotal wall are also seen
7
Q
What is the differential for hydronephrosis?
A
- Blockage >> Reflux
- Stone in renal pelvis or ureter
- Most common cause of blockage in women and men
- Often associated with flank pain and hematuria
- Enlarged prostate – BPH or cancer (older men)
- Dilatation often bilateral
- Pregnancy (women)
- Often unilateral on the right side
- May have discomfort, rarely hematuria unless infection
- Blood clot in renal pelvis or ureter
- Much less common than stone
- Anticoagulation, coagulopathy, underlying process
- Urinary tract tumor (renal pelvis, ureter, bladder) or pelvic tumor blocking ureter
- usually older patient
- Typically painless hematuria
- Trauma – known history (blunt, penetrating, iatrogenic), hematuria, pain
- Neurogenic bladder – usually known history, dilatation often bilateral
- Ureter stricture/scarring due to prior stone, iatrogenic, trauma, congenital
- Congenital UPJ obstruction or megaureter – intermittent discomfort, rarely hematuria
- Persistent or recurrent urinary tract infection – signs and symptoms of infection