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Scrotal Ultrasound > Scrotal Pathology > Flashcards

Scrotal Pathology Flashcards

1
Q

What is testicular rupture?

A

Disruption to the tunica albuginea caused by trauma.

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2
Q

What are the US appearances of testicular trauma?

A

Focal change to testicle parenchymal pattern (haemorrhage or infarction)
Interruption of tunica albuginea
Irregular testicular contour
Scrotal wall thickening
Disruption of blood flow along testicle surface

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3
Q

What are some complications of testicular trauma?

A

Hydrocele and haematocele
Epididymitis
Torsion

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4
Q

What is testicular fracture?

A

Discontinuity of the normal testicular parenchyma (may have disruption of tunica albuginea)

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5
Q

What are the US appearances of a haematocele (two stages)?

A

Acute - echogenic fluid with highly visible echoes that move
Old - low-level echoes and fluid levels/septations. More complex and develop cystic components.

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6
Q

What do haematoceles develop from?

A

Bleeding/rupture of the pampiniform plexus or other extratesticular structures

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7
Q

What are the two causes of torsion?

A

Absence of gubernaculum leads to twisting of the testicular within the tunica vaginalis (bell-clapper deformity) or outside of the tunica vaginalis (perinatal torsion)

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8
Q

What are the S+S of testicular torsion?

A

Sudden onset of pain which can cause nausea and vomiting
Swelling on affected side

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9
Q

Who are the patients most likely to get torsion?

A

Adolescents (peak age 14yo)
Undescended testicles

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10
Q

What are the US appearances of very early torsion?

A

Usually normal grey-scale appearance. No colour flow.

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11
Q

What are the US appearances of torsion of 4-6 hours?

A

Swollen and hypoechoic testicle. Lobes of testes become well-defined from interstitial and septal oedema. No colour flow.

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12
Q

What are the US appearances of torsion of 24 hours?

A

Heterogenous testicle from haemorrhage, necrosis, infarction, vascular congestion. No colour flow.

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13
Q

What are other associated findings of torsion?

A

Testicular knot - twisted spermatic cord immediately superior to testis displays whirlpool sign with CD.
Scrotal skin thickening
Reactive hydrocele
Epididymal head enlargement and decreased echogenicity

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14
Q

What are some of the imaging appearances post spontaneous de-torsion, depending on the length of time since resolution?

A

Intratesticular flow may be minimal or increased. Extratesticular flow increased.

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15
Q

What pathology produces similar S+S to testicular torsion?

A

Torsion of the appendix testis or appendix epididymis.

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16
Q

What are the US appearances of testicular or epididymal appendix torsion?

A

Small, hypoechoic mass between epi head and superior testis.
Increased flow around the mass.

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17
Q

What is epididymo-orchitis?

A

Infection of epididymis and testes

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18
Q

What causes epididymo-orchitis?

A

Spread of UTI down spermatic cord.
Viruses, syphilis, tuberculosis, trauma.

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19
Q

What are the signs and symptoms of epididymo-orchitis?

A

Scrotal pain increasing over 1-2 days
Fever
Urethral discharge

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20
Q

What are the US appearances of epididymitis?

A

Enlarged, hypoechoic epididymis
Focal hyperechoic areas (haemorrhage)
Hyperaemia
Increased flow velocity and low-resistance waveform

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21
Q

What are the US appearances of orchitis?

A

Enlarged testis
Focal - affected areas hypoechoic
Diffuse - whole testis hypoechoic

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22
Q

What is the most helpful imaging tool to differentiate between torsion and infection?

A

Colour Doppler

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23
Q

What are the US appearances of testicular infarction?

A

Decreased or absent flow
High resistance flow with little to no diastolic flow (reversed end diastolic indicates threatened infarction)
Focal - no flow in affected areas and heterogenous parenchyma

24
Q

What are spermatoceles?

A

Dilation of the efferent ducts of the epididymis. Contain spermatozoa.

25
Q

What are some findings that may suggest a spermatocele over a epididymal cyst?

A

Spermatocele always in epi head
Contain internal echoes and septa
More common in patients with vasectomy

26
Q

How do you tell a large tunica albugenia cyst from a hydrocele?

A

Hydrocele will not distort the testicle.

27
Q

Where are the three areas you can get benign extratesticular cysts?

A

Epididymis, tunica albuginea, and between layers of the tunica vaginalis.

28
Q

What are the two types of causes of varicoceles?

A

Primary - venous valve incompetence
Secondary - masses, hydronephrosis, cirrhosis, nutcracker syndrome, retroperitoneal mass.

29
Q

What are the US appearances of a varicocele?

A

Numerous tortuous tubes within spermatic cord
Measure >2mm diameter
Increase in size with valsalva
Retrograde fill with CD and valsalva

30
Q

How can we differentiate between a tumour vs. a scrotal abscess?

A

Clinical symptoms
Interval change

31
Q

What are the US appearances of an intratesticular haematoma (two stages)?

A

Acute - isoechoic or heterogenous compared to parenchyma
Chronic - hypoechoic or anechoic

32
Q

What is a physical sign unique to torsion of the epididymal or testicular appendix?

A

Blue discolouration of the skin

33
Q

What other pathologies are hydroceles associated with?

A

Epididymo-orchitis, torsion

34
Q

What causes a pyocele?

A

Untreated infection, abscess rupture into the space

35
Q

What are some events/pathologies that cause of a haematocele?

A

Trauma, surgery, neoplasms, torsion

36
Q

What are the US appearances of a hydrocele?

A

anechoic (or low-level echoes) excess fluid on the anterolateral side of testicle.

37
Q

What are the US appearances of a pyocele/haematocele?

A

internal echoes, thickened septations, loculations.
Air within space indicates abscess (abscess can occur without air)

38
Q

What is a sperm granuloma and where are they located?

A

Chronic inflammatory reaction to extravasation of spermatozoa.
Located anywhere in epididymis or vas deferens.

39
Q

What are the US appearances of sperm granuloma?

A

Well-defined, heterogenous, solid mass that’s hypo or isoechoic to epi.
Calcs not generally present.
Increased flow when inflammation present.

40
Q

What is tubular ectasia and where is it located?

A

Dilation of the rete testes. Located in the rete testes (mediastinum of the testicle).

41
Q

What causes tubular ectasia?

A

Anything that may obstruct the movement of sperm from the testes to the epididymis.

42
Q

What are the US appearances of tubular ectasia?

A

Prominent hypoechoic channels near the mediastinum.
Avascular.

43
Q

What other pathology may tubular ectasia mimic? How can you differentiate between the two?

A

Intratesticular varicocele. Use CD with valsalva - tubular ectasia will not fill with colour.

44
Q

What is microlithiasis and what US criteria must be seen to make this diagnosis?

A

Tiny calcs throughout the testicles.
Calcs must be <3mm each and there must be more than ≥5 calcs per image.

45
Q

What congenital abnormalities/pathologies is microlithiasis associated with?

A

Cryptorchidism, infertility, varicoceles, testicular atrophy.

46
Q

What are the US appearances of intratesticular varicocele?

A

Hypoechoic tubes passing from mediastinum to parenchyma.

47
Q

What anatomical abnormality increases the likelihood of testicular cancer?

A

Cryptorchidism.

48
Q

What are the S+S of testicular cancer?

A

Painless lump
Testicular enlargement
Vague scrotal discomfort

49
Q

What are the US appearances of a seminoma?

A

Hypoechoic
Smooth, well-defined walls
Usually no calcs

50
Q

What are the US appearances of a teratoma?

A

Complex (solid + cystic)
Well-defined borders
Dense foci that produce shadowing

50
Q

What are the US appearances of a embryonal cell carcinoma?

A

Hypoechoic
Calcs
Irregular borders
May contain cystic areas

51
Q

What are the US appearances of a choriocarcinoma?

A

Irregular borders
Complex lesion
Focal necrosis and calcs

51
Q

What are the US appearances of mets to the testes?

A

Solid hypoechoic lesion (uncommon but can appear hyperechoic or heterogenous)

51
Q

What are the US appearances of testicular lymphoma and leukaemia?

A

Enlarged testes
Diffuse or focal areas of decreased echogenicity
Hypervascularity

52
Q

What are the US appearances of chronic lymphocytic leukaemia?

A

Well-circumscribed
Anechoic
Posterior enhancement

53
Q

What are three different anatomical anomalies that may arise in relation to the testes?

A

Cryptorchidism
Anorchia
Polyorchidism

54
Q

What are the complications of cryptorchidism?

A

Infertility (higher temperatures inhibiting spermatogenesis)
Higher risk of cancer and torsion

Scrotal Ultrasound (2 decks)

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