Scrotal Pathology Flashcards
what can cause significant testicular parenchymal injury or hemorrhage?
scrotal trauma
What is scrotal trauma?
a direct blow to the scrotal sac
what can definitely alter the normal homogeneous appearance?
scrotal trauma
Look for a change in _________when you scan testicles
architecture
What do you need to determine when there is trauma?
has there been a rupture….emergency!!
requires surgery
must be fixed within 72 hours for 90% survival, after 72 hrs only 45% of testes are saved.
What causes an irregular testicular contour?
trauma
what causes scrotal wall thickening and hematocele?
trauma
What is a hydrocele?
fluid formed between the visceral and parietal layers of the TUNICA VAGINALIS
what is a hematocele?
blood btw the visceral and parietal vaginalis
low level echoes
What is a hematoma?
collection of blood
What causes a hematocele?
bleeding of panpiniform plexus or other extratesticular structure
How does a hematocele appear sonographically?
acute:
echogenic with echoes
over time:
low level echoes with septations
how does a hematoma appear sonographically in the scrotum?
heterogeneous areas within scrotum
more complex
avascular
displacement of testes
heterogeneous
What is epididymitis?
infection
spread of lower UTI or STD via spermatic cord
most common cause of acute scrotal pain in adults
What are the clinical symptoms of epididymitis?
scrotal pain for 1-2 days
fever
urethral discharge
scrotal wall edema
most common cause of acute scrotal pain in adults
how does epididymitis appear sonographically?
enlarged hypoechoic gland
increased flow
increased velocities in systole and diastole
low resistance wave form
hydrocele
see slide 72-77for picture
What is orchitis?
once infection (epididymitis) has spread to the testicle
also associated with hydrocele and pyocele
hyperemic flow
what is hyperemic flow?
increase color doppler
Excessive swelling can cause ____________to the testicular ________ supply
obstruction
blood
what might occur with orchitis?
infarction
When does torsion typically occur?
during adolescence 12-18
what is the most common etiology for testicular torsion?
anomaly - Bell Clapper Deformity
What is the bell clapper deformity?
etiology for torsion
tunica vaginalis completely surround the testis, epididymis and distal spermatic cord causing a twisting
60% anatomic anomaly on both sides
What kind of testes is 10x more affected for torsion?
undescended testes
What structure is involved in torsion?
spermatic cord
What happens to blood flow with torsion?
compromised blood flow
venous flow with occluded veins - will happen first
arterial flow obstruction leads to ischemia
What symptoms present with torsion of spermatic cord?
true emergency
suddenonset of acute pain
swelling
nausea and vomiting
How soon do you need to surgically fix torsion to save the testicle?
5-6 hrs 100%
6-12 hrs 70%
beyond 12 hrs 20%
What will the testicle look like if it’s torsed?
after 4-6 hrs testis swollen hypoechoic
After 24 hrs - heterogenous
Scrotal thickening and hydrocele
What is torsion of the testicular appendages?
“the blue dot”
small piece of tissue on the testicle is twisted (seen by doctor not sonographer)
most common cause of acute scrotal pain in PREPUBERTAL boys
What is an epididymal cyst? (aka: extra testicular masses)
benign fluid collection
typical cyst criteria
What is a spermatocele?
extra testicular mass
cystic dilation of the efferent duct of the epididymis
where would a spermatocele be found?
located in the epi head
seen often following a vasectomy
contain proteinaceous fluid and spermatozoa
What is a varicocele?
abnormal dilation of the veins of the PAMPINIFORM plexus within the spermatic cord
what side is is often associated with varicocele?
more common on the Left because of the left renal vein
What causes a varicocele?
incompetent valves in the spermatic vein
pressure from renal hydronephrosis, mass, liver cirrhosis
What is associated with infertility - most common and correctible?
varicocele
see slide 102+ for images
what do you have the patient do to prove varicocele?
valsalva
What is a pyocele?
pus filled
abscess
What is a hematocele?
blood - trauma
what is hydrocele?
serous fluid - swelling
What is a tubular ectasia of the rete testis?
benign mass
Assoc with epididymial obstruction due to trauma or inflammation
Cystic lesion in mediastinum testis
Bilateral asymmetry
what is microlithiasis?
tiny calcifications in the testicle
multiple
(two or three is not really microlithiasis)
What is associated with microlithiasis?
cryptorchidism (undescended testis)
infertility
klinefelter’s (genetic)
varicocele
What is a seminoma?
malignant mass
most common malignancy of the testicle*
cryptorchidism
painless scrotal mass
solid, hypoechoic nodule
What are the risk factors for seminoma?
Family history
Cryptorchidism
Down’s syndrome
Smoking
Infertility
White race
What is a germ cell tumor?
non seminoma
Spread more quickly
High levels of serum
Alpha feta protein
Teratoma - infants
Choriocarcinoma - elevated hCG
Embryonal cell
What is a leydig cell tumor?
uncommon
benign in children
malignant in adults
non germ cell
What is cryptorchidism?
undescended testicle
where might an undescended testicle be found?
abdomen
inguinal canal
other location
what percent of undescended testicles are found in the inguinal canal?
80%
more common in premature babies
What is an orchiopexy?
surgically bringing down of the testicle
What is a scrotal hernia (inguinal)?
bowel (most common)
omentum or other structures into the scrotum
look for peristalsis of the bowel
What is an indirect hernia?
finish slide 130
a congenital lesion
bowel and peritoneum do not herniate directly through a weakness in abd wall but through a patent processus vaginalis (congenital defect) and into the scrotum
goes through the internal ring
higher risk
What is a direct hernia?
finish slide 131
acquired
occurs when a weak spot develops in the lower abd musculature
due to lifting heavy objects, coughing, straining, pregnancy, constipation
lower
