Pediatrics: Reproductive Flashcards
Hydrometrocolpos
When the uterus and vagina are expanded with blood due to obstruction
Causes of hydrometrocolpos
- Imperforate hymen (most common)
- Vaginal stenosis
- Lower vaginal atresia
- Cervical stenosis
Complications of hydrometrocolpos
Hydronephrosis (due to mass effect from distended uterus)
Hydrometrocolpos is associated with which congenital uterine anomaly?
Uterine didelphys
Note: 75% of cases have a transverse vaginal septum.
RLQ pain in a young female with ultrasound demonstrating an enlarged right ovary with displaced follicles containing fluid-debris levels…
Think ovarian torsion
Is idiopathic ovarian torsion more common in kids or adults?
Kids (due to excessive mobility of the ovary in kids)
Note: Ovarian torsion in adults is usually due to a mass.
When should you consider an ovary to be enlarged enough to be suspicious of ovarian torsion in a kid?
When it is at least 3x larger than the contralateral ovary
Note: There is a lot of variability in ovarian size in the pediatric population.
What are the most common ovarian neoplasms in a child?
- Benign dermoids/teratomas (67%)
- Germ cell cancer (25%)
What imaging characteristics make an ovarian mass suspicious for cancer?
- Mural nodules
- Thick septations
- Peritoneal implants
- Ascites
- Lymphadenopathy
Congenital hydrocele is due to…
A patent processus vaginalis, allowing peritoneal fluid into the scrotal sac
How can you differentiate a hematocele and pyocele?
Clinically
Note: Both hematoceles and pyoceles appear as complicated hydroceles with septations.
Varcicoceles are more common on which side?
Left
Next step if you identify an isolated right-sided varicocele…
Abdominal CT to look for pathology (e.g. extrinsic compression, renal vein thrombosis, portal hypertension with splenorenal shunting)
Note: Isolated right varicoceles are very rare without other pathology.
What is the most common cause of idiopathic scrotal edema?
IgA vasculitis (Henoch-Schonlein purpura)
Common causes of unilateral right-sided varicocele
- Extrinsic compression of the right gonadal vein (e.g. nutcracker syndrome, renal cell carcinoma, retroperitoneal fibrosis)
- Renal vein thrombosis
- Portal hypertension (causing a splenorenal shunt)
Differential for acute scrotal pain in a kid
- Torsion of the appendix testis
- Testicular torsion
- Epididymo-orchitis
Causes of orchitis
- Progression of epididymitis (by far most common)
- Mumps (rare)
10 y/o M with acute onset scrotal pain and a “blue dot sign” on physical exam…
Think torsion of the appendix testis (but exclude testicular torsion with scrotal ultrasound)
What is the most common cause of acute scrotal pain in males age 7-14?
Torsion of the appendix testis
What is the testicular appendage?
A vestigial remnant of a mesonephric duct
Note: Clinically significant because it can torse, causing acute scrotal pain.
Classic imaging appearance of torsion of the appendix testis
Enlargement of the testicular appendage to greater than 5 mm WITHOUT evidence of testicular torsion
Major risk factor for testicular torsion
Bell clapper deformity (failure of the tunica vaginalis to connect with the testis, allowing more testicular mobility than usual)
Note: This is often bilateral, so treatment is a bilateral orchiopexy in the setting of torsion.
5 y/o M with afebrile, painless, scrotal swelling and a heterogeneous extra-testicular scrotal mass with internal vascularity on color doppler…
Think rhabdomyosarcoma
Note: These are usually embryonal from the spermatic cord or epididymis.
Management of testicular microlithiasis
Follow-up screening ultrasounds in 6 months, then annually to look for germ cell tumors
Note: This is controversial.
