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Peds > peds- scrotum and testes > Flashcards

peds- scrotum and testes Flashcards

1
Q

what transducer do you use for pediatric pelvis us?

A
  • high resolution linear array transducer

- 10-15 MHz (usually 12 MHz)

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2
Q

testes origin and hormone secretion?

A
  • testes have mesenchymal origin

- secrete hormones that affect mesonephric duct (woliffian)

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3
Q

when ducts are exposed to testosterone what occurs?

A

male sexual differentiation occurs

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4
Q

wolffian duct develops into what? (5)

A
  • rete testis
  • efferent ducts
  • epididymis
  • vas deferens
  • seminal vesicles
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5
Q

the prostate is formed separatley from what?

A

the urogenital sinus

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6
Q

failure for descent of the testes can result in?

A
  • infertility or malignancy
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7
Q

what are the pathways for the testes to desend?

A
  • inguinal canals are pathways for the testes to descend from their intra-abdominal location through the anterior abdominal wall into the scrotum
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8
Q
A
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9
Q

testes descent takes place at what weeks of gestation? What are they dependent on?

A
  • desent between 25-32 weeks GA
  • Dependant on androgen secretion
  • during the 1st 3 months after birth most undescended testes decend (does not occur after 1 year)
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10
Q

u/s apperance of newborn testes?

  • echogenicity
  • shape
  • diameter
  • whats not seen
  • doppler
A
  • homogeneous low to medium level echogenicity
  • spherical or oval in shape
  • 7-10mm diameter
  • epididymis and mesiastinum testes are usually nor seen in neonate
  • doppler will show a pulsatile foci or colour with no branching
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11
Q

u/s apperance of testes by puberty?

  • echogenicity
  • mediastinum
  • tunica albuginea
  • doppler
A
  • homogeneous medium-level echoes
  • echogenic linear structure along vertical axis which represents mesiastinum testis
  • tunica albuginea is a thin echogenic line around the testis
  • doppler will show branching of vessels
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12
Q

measurement of testes by puberty?

- length, depth, width

A

3-5cm long

2-3 cm depth and width

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13
Q

congenital abnormalities of testes? (6)

A
  • absence
  • ectopic testes
  • cryptochordism
  • retractile testis
  • small testis
  • true hermaphroditism
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14
Q

anorchism?

A

bilateraal testicular absence

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15
Q

monorchism?

A
  • unilateral testicular absence

- usually left sided

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16
Q

polyochism?

A
  • testicular duplication

- usually a small single accessory testicle

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17
Q

5 abnormal locations of testis?

A
  • contralateral scrotum
  • peritoneum
  • superficial inguinal pouch
  • femoral canal
  • suprapubically
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18
Q

when do ectopic testes occur?

A
  • when the gubernaculum passes to an abnormal location and the testes follow it
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19
Q

what is transverse testicular ectopia?

A

both testes are in the same hemisctotum

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20
Q

what is cryptochordism? what is it associated with? where are they typically located?

A
  • incomplete testicular descent into the scrotum
  • associated with urological abnormalities
  • typically located within the inguinal canal
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21
Q

Cryptochordism clinical presentations?

A
  • no testes palpated in the scrotum

- one testic not palpated

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22
Q

sono features of cryptochordism? (5)

A
  • smaller testis
  • located along the path of testicular descent
  • higher echogenicity than other testicle
  • often indistinguishable from a lymph node
  • renal exam should be performed because of association with renal anomalies
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23
Q

retractile testis?

A
  • one that is fully desended but can move freely from its intrascrotal position to the groin
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24
Q

what is retractile testis caused by?

A
  • hyperactive cremasteric reflex

- no increase in infertility

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25
Q

smaller testis causes? (7)

A
  • cryptorchidism
  • torsion
  • inflammation
  • varicocele
  • radiation treatment
  • trauma
  • congenital causes (klinfelter’s syndrome and primary hypopituitarism)
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26
Q

what is true hermaphroditism?

A
  • both ovarian and testicular tissue

- separate or ovotestis

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27
Q

hermaphroditism testicular vs ovarian tissue on u/s?

A

testicular portion: homogeneous

ovarian portion: heterogeneous with small follicles

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28
Q

hermaphroditism clinically? pre vs. post puberty

A

prepubertally- ambigious genitialia

postpubertally:
boys- gynecomastia, cyclic hematuria, cryptorchidism
girls- amenorrhea

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29
Q
A

true hermaphroditism

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30
Q

Acute Scrotal Pain and Swelling- causes of pediatric pain or swelling? (6)

A
  • torsion
  • epididymitis with or without orchitis
  • torsion of appendages
  • trauma
  • acute hydrocele
  • incarcerated hernia
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31
Q

what is testicular torsion?

A
  • testis and spermatic cord twist one or more times, obstructing flow
  • generally unilateral
  • highest in infancy and adolescence
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32
Q

what are the 2 types of torsion?

A
  1. extravaginal

2. intravaginal (more common)

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33
Q

extravaginal torsion?

A
  • neonates/ in utero
  • spermatic cord poorly fixed in ingunial canal
  • all scrotal contents are strangulated
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34
Q

intravaginal torsion?

A
  • more in adolescents
  • tunica vaginalis completely surrounds testis and inserts high on spermatic cord
  • testis rotates freely on its vascular pedicle
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35
Q

what is bell-and-clapper deformity?

A
  • predisposing factor for torsion
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36
Q

extravaginal torsion clinical features?

A
  • swollen and red scrotum
  • firm painless enlarges testicle

in utero- salvage of testis is unlikely

after birth- immediate surgery

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37
Q

intravaginal torsion clinical features?

A
  • sudden onset of scrotal or low abdominal pain
  • history or similar self-limited episodes
  • N & V
  • severely tender scrotum, swollen, hyperemia
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38
Q

intravaginal torsion treatment?

  • what is the surgery called?
  • there is a 100% salvage rate within ___hrs of pain onset
A
  • immediate surgury (orchidopexy)

- 100% salvage reate within 6hrs of pain onset

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39
Q

extravaginal torsion sono features? recent vs. chronic

A

recent: heterogeneously enlarged with hypo and hyperechoic areas
chronic: normal size or enlarged, peripheral Ca2+

  • scrotal thickening
  • hydrocele
  • no doppler signals
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40
Q

intravaginal torsion- sono features?

  • early stage
  • 4-6 hrs
  • after 24 hrs
A

early: normal

4-6 hrs: hypoechoic from edema

after 24hrs: heterogeneous from hemorrhage and infaction

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41
Q

intravaginal torsion- sono features? (5)

A
  • tetsicle of often TRV
  • reactive hydrocele
  • skin thickening
  • enlarged, twisted spermatic cord
  • hyprechoic epididymis
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42
Q

Colour flow Doppler in torsion- what you need to demonstrate?

A
  • absent blood flow in affected testis
  • normal flow in contralateral testis
  • spontaneous detorsion causes normal or increased flow
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43
Q
A

extravaginal torsion

  • Atrophy of the right testicle in a 2 month old neonate possibly caused by a an old testicular torsion
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44
Q
A

intravaginal torsion

  • Acute testicular torsion
  • 13yo
  • enlarged left epididymis
  • swollen hypoechoic testicle
  • absence of flow
45
Q

Acute epididymitis/epididymo-orchitis is more common in?

A
  • pubertal boys
46
Q

what is Acute epididymitis/epididymo-orchitis?

A
  • inflammation of epididymis and testis
47
Q

what cause Acute epididymitis/epididymo-orchitis?

A
  • pyogenic, viral, or myocotic infection

- in adolescence often secondary to STD’s

48
Q

clinical signs of Acute epididymitis/epididymo-orchitis?

A
  • simular to torsion except:
  • most gradual onset pain
  • fever
  • pyuria
49
Q

treatment of Acute epididymitis/epididymo-orchitis?

A

antibiotics

50
Q

what is mumps orchitis?

A
  • seen in prepubertal boys infected with mumps
51
Q

Acute epididymitis/epididymo-orchitis on u/s?

A
  • foal or diffuse enlargement epididymis with coarse echoes
  • focal orchitis shows hypoechoic areas
  • doppler- hyperemic
  • reactive hydrocele
  • skin thickening
52
Q
A

acute epididymitis

53
Q
A

acute epididymo-orchitis

54
Q

what is the Most common cause of acute scrotal pain in prepubertal boys?

A

torsion of the appendages

55
Q

Torsion of the Appendages is typically seen in what age group?

A

6-12 years

56
Q

Blue-dot sign?

  • what is it associated with?
A

small, firm, round, mobile, tender paratesticular mass with bluish discolouration visible through skin

  • associated with torsion of the appendages
57
Q

Torsion of the Appendages on u/s?

A
  • solid, ovoid mass with variable sized hypoechoic centre and hyperechoic rim
  • adjacent to superior aspects of the testis or epididymis
58
Q
A

torsion of the appendages

59
Q

Testicular Trauma results in?

A
  • hematoma or rupture
60
Q

Testicular hematoma ?

A
  • avascular masses with varying echogenicity
61
Q

testicular rupture?

A
  • surgical emergency
  • assess for disruption of tunica albuginea, which is normally a smooth echogenic line
  • hematocele present
62
Q
A

testicular rupture

63
Q

Sonography plays an important role in the evaluation of scrotal masses by? (3)

A
  • confirming the presence of a lesion
  • determining its orgion
  • characterizing its contents
64
Q

most intratesticular masses are? most extratesticular masses are?

A

most intratesticular masses are malignant

most extratesticular masses are benign

65
Q

what % of testicular tumors are malignant?

A

80%

66
Q

Two peak incidences of testicular neoplasms?

A
  • children <2.5 years

- late asolescent

67
Q

Children with cryptorchidism are most likely to develop?

A

30-50 times more likely to develop a testicular neoplasm

68
Q

Intratesticular Scrotal Masses presentation?

A
  • palpable mass in scrotum
69
Q

2 non-primary testicular neoplasms?

A
  • lymphoma

- leukemia

70
Q

2 categories of primary testicular neoplasms?

A
  • germ cell tumors

- non-germ cell tumors (stromal)

71
Q

testicular neoplasms- germ cell tumors? (6)

A
  • seminoma
  • yolk sac tumor
  • embryonal carcinoma
  • choriocarcarcinoma
  • teratocarcinoma
  • teratoma (benign)
72
Q

testicular neoplasms- non-germ cell tumors (stromal)? (2)

A
  • leydig cell tumor

- sertoli cell tumor

73
Q

u/s apperance of Most testicular tumors?

A 
Hypoechoic 
Solid
Well-defined
Areas of hemorrhage or necrosis 
Calcifications
Hydrocele 
Hypervascular if large
74
Q

Germ Cell Tumors: Seminoma?

A
  • most common in adult, rare in children
  • 15-35 yr olds
  • malignant
75
Q

Germ Cell Tumors: Seminoma associated with?

A

cryptochordism

76
Q

Germ Cell Tumors: Seminoma on u/s?

A
  • hypoechoic masses
  • heterogenous
  • distorts testis if large
  • vascular
77
Q
A

seminoma

78
Q

Yolk Sac Tumor AKA?

A

endodermal sinus tumor

79
Q

Yolk Sac Tumor most common in?

A

prepubertal children

  • primarily in 1-2 year olds
  • highly malignant
80
Q

clinical presentaiton of Yolk Sac Tumor?

A
  • painless scrotal mass

- increased AFP

81
Q

Embryonal carcinoma?

A
  • usually in adolescence
  • rare
  • highly malignant
82
Q

Choriocarcinoma?

A
  • highly malignant- worst prognosis
  • rare
  • increased B-hCG
83
Q

Teratoma?

A
  • benign

- affects children <4yrs

84
Q

Teratoma on u/s?

A
  • complex mass
  • hypoechoic area (serous fluid)
  • hyperechoic areas (fat and calcification)
85
Q

Stromal Tumors: Leydig and Sertoli characteristics?

A
  • benign
  • slow-growing
  • usually hormone secreting
  • small, well circumscribes
  • hypoechoic
86
Q

Leydig?

A
  • 3-6 years old
  • testosterone secreting
  • precocious virilization
87
Q

Sertoli?

A
  • 1 year old
  • most hormone inactive
  • some secreting
  • gynecomastia
88
Q

Extratesticular Causes of Scrotal Masses (5)?

A 
Hydrocele
Hematocele
Scrotal hernia/Inguinal hernia
Varicoceles
Spermatoceles/Epidydimal cysts
89
Q

Extratesticular Causes of Scrotal Masses (5)?

A 
Hydrocele
Hematocele
Scrotal hernia/Inguinal hernia
Varicoceles
Spermatoceles/Epidydimal cysts
90
Q

what is Hydrocele?

A
  • an abnormal collection of serous fluid in the scrotal sac
91
Q

causes of Hydrocele?

A
  • trapped peritoneal fluid- absorbs within 18 months of life
  • communicating hydrocele- if processes vaginalis fails to close
92
Q

sono apperance of Hydrocele?

A
  • anachoic
  • well-demarcated
  • area with increased TT
93
Q

Acquired hydrocele?

A

Older children
Reactive hydrocele might be caused by infection, torsion, trauma or tumor
SONO – fluid with septations & echoes

94
Q
A

hydrocele

95
Q

Hematocele?

A

blood in tunica vaginalis

96
Q

Hematocele causes?

A
  • surgury or trauma

- might be bleeding disorders or malignant tumor

97
Q

sono features of Hematocele?

A
  • fluid collection with debris

- septations

98
Q

varicocele?

A
  • dilated veins of pamphiform plexus

- mostly on left side

99
Q

varicocele sono features?

A
  • small
  • serpentine
  • anechoic structures
  • flow on doppler
100
Q

inguinal hernia?

A
  • patent processus vaginalis
  • scrotal mass
  • more often on right side
101
Q

ingunial hernia- sono?

A
  • bowel loops with air or fluid in scrotum
  • normal testes
  • herniated amentum
  • no peristaltis in incarcerated hernia
102
Q

Testicular Microlithiasis?

see in healthy patients and in patients with? (3)

A
  • asymptomatic
  • seen in healthy patients and in patients with:
  • downs syndrome
  • cryptorchidism
  • klinefelters syndrome
103
Q

Testicular Microlithiasis on u/s?

A
  • calcified debris in seminiferous tubules
  • 1-3mm hyperechoic
  • non shadowing foci
104
Q

Testicular Microlithiasis associated with?

A
  • diseases that have increased risk of malignancy
105
Q

Spermatocele occur in?

A
  • epididymis head

- consist of fluid (sprem and sediment)

106
Q

Epididymal cysts?

A

Contain no spermatazoa, in epi head, body and tail, anechoic

Can present as a mass

107
Q

Epididymal cysts?

A

Contain no spermatazoa, in epi head, body and tail, anechoic

Can present as a mass

108
Q
A

ingunial hernia

Peds (18 decks)

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