PEDIATRIC Section 12: Reproductive Flashcards
Essentially the vagina won’t drain the uterus.
Hydrometrocolpos
Hydrometrocolpos on US
expanded fluid-filled vaginal cavity with associated distention of the uterus.
How is Hydrometrocolpos presented?
infant + mass in the uterus
teenager + delayerd menarche
“Midline pelvic mass” + hydroneprhosis (mass effect)
Most common cause of Hydrometrocolpos
Imperforate hvmen (most common’)
vaginal - cervical stenosis
lower vaginal atresia
Hydrometrocolpos is associated with what condition?
Uterus Didelphys (75% has a transverse vaginal septum)
In an adult, ovarian torsion is almost always due to a mass. In a child, torsion can occur with a normal ovary,
secondary to?
excessive mobility of the ovary.
What will you see in ovarian torsion?
you are going to see an enlarged (swollen) ovary, with peripheral follicles, with or without arterial flow.
How do you know if the ovaries are enlarged in Peds?
compare the ovary in question to the contralateral size.
Suspect torsion if ovary = 3x the size of the opposite “normal” ovary.
Give an adolescent ovarian torsion finding
Fluid-Debris Levels within the displaced follicles
2/3 of ovarian neoplasms are?
1/3 is cancer - Most common?
Benign - Dermoids/teratomas
Cacner - germ cells (75%)
You suspect cancer in the ovary if you see these
Nodules and thick septations
+ ascites
+ lymphadenopathy
the most common cause of painless scrotal swelling.
Collection of serous fluid = hydrocele
result from a patent processus vaginalis that permits entry of peritoneal fluid into the scrotal sac.
Hydrocele
It is a complicated hydrocele if you see what?
Septations
Varicocele
Most of these are idiopathic and found in adolescents and young adults.
More frequent on the LEFT.
Next step:
Isolated right sided varicocele =
Abdomen CT - Exclude extrinsic mass, renal vein thrombus, or portal hypertension causing a splenorenal shunt
should stir suspicion for abdominal pathology (nutcracker syndrome, RCC, retroperitoneal fibrosis)
the most common cause of idiopathic scrotal edema
HSP (henoch schonlein purpura)
The top three considerations in a child with acute scrotal pain are:
(1) torsion of the testicular appendage
(2) testicular torsion
(3) epididymo-orchitis.
Isolated orchitis =
Mumps
Nearly always occurs as a progressed epididymitis.
most common cause of acute scrotal pain in age 7-14.
Torsion of the Testicular Appendages
vestigial remnant of a mesonephric duct.
testicular appendage
Sudden onset of pain + Blue dot sign on PE
Torsion of the Testicular Appendages
What is the best indicator of Torsion of the Testicular Appendages?
> 5mm enlargement
Results from the testis and spermatic cord twisting within the serosal space leading to ISCHEMIA
Torsion of the Testicle
Cause of Testicular Torsion?
ailure ofthe tunica vaginalis and testis to connect
“Bell Clapper Deformity”
Torsion of the Testicle
Torsion of the Testicle findings
Findings will be absent or asymmetrically decreased flow, asymmetric enlargement, and slightly decreased echogenicity of the involved ball.
Testicular Masses can be thought of as?
Extra and Intra
If the mass is extratesticular, the most likely diagnosis is?
embryonal rhabdomyosarcoma
from the spermatic cord or epididymis.
Age: 5
Hx: Painless scrotal swelling + afebrile + `US: Heterogeneous Vascular EXTRA-testicualr mass =
embryonal rhabdomyosarcoma
This appears as multiple small echogenic foci within the testes.
Testicular Mircolithiasis
Testicular Mircolithiasis have a relationship with what tumor?
Germ Cell Tumors (controversiaP
Testicular cancers in PEDs are likley?
Germ Cell (90%)
Non Germ Cell (10%)
- Sertoli
- Leydig
Testicular Germ Cell tumors are likely?
Seminoma (40%) - 4th decade
Non-Sminoma (60%)
- Teratoma
- Yolk Sac
- Mixed GCT (Choriocarcinoma)
The two Germ Cell Tumors seen in the first decade of life
Yolk Sac Tumor
Teratoma
Heterogeneous Testicular Mass in < 2 year old + elevated AFP
Yolk Sac Tumor
< 2 y.o + Testicular mass + aggressive (unlike ovarian)
Teratoma
2nd decade + Testicular mass + Agressive (High mortality) + inc b-HCG
Choriocarcinoma
“Multiple hypoechoic masses of the testicle”
Testicular lymphoma
Testicular calcifications
Microcalc = ?
Macrocals = ?
Microcalc = Seminoma
Macrocals = Germ Cell Tumor
This is the most common tumor of the fetus or infant
Sacrococcygeal Teratoma
These soUd and/or cystic masses are typically large and found either on prenatal imaging or birth
Sacrococcygeal Teratoma
Mass effects of Sacrococcygeal teratoma?
effect on the GI system
hip dislocation
nerve compression leading to incontinence.
Sacrococcygeal Teratoma Types
-Type 1 - Totally extra pelvic
-Type 2 - Barely pelvic, but not abdominal
-Type 3 - Some abdominal
-Type 4 - Totally inside abdomen
** this one has the highest rate o f malignancy.
