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
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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
  • Extratesticular mass – usually benign
    • Cyst: Spermatocele or epididymal cyst
    • Solid: lipoma, adenomatoid tumor, inguinal hernia
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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
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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
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5
Q

What are the major findings of varicocele on imaging?

A

Large collection of vessels that show blood flowing away on imaging

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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
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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
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