Scrotal Pathology

Question 0

what can cause significant testicular parenchymal injury or hemorrhage?

Answer 0

scrotal trauma

Question 1

What is scrotal trauma?

Answer 1

a direct blow to the scrotal sac

Question 2

what can definitely alter the normal homogeneous appearance?

Answer 2

scrotal trauma

Question 3

Look for a change in _________when you scan testicles

Answer 3

architecture

Question 4

What do you need to determine when there is trauma?

Answer 4

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.

Question 5

What causes an irregular testicular contour?

Answer 5

trauma

Question 6

what causes scrotal wall thickening and hematocele?

Answer 6

trauma

Question 7

What is a hydrocele?

Answer 7

fluid formed between the visceral and parietal layers of the TUNICA VAGINALIS

Question 8

what is a hematocele?

Answer 8

blood btw the visceral and parietal vaginalis

low level echoes

Question 9

What is a hematoma?

Answer 9

collection of blood

Question 10

What causes a hematocele?

Answer 10

bleeding of panpiniform plexus or other extratesticular structure

Question 11

How does a hematocele appear sonographically?

Answer 11

acute:

echogenic with echoes

over time:

low level echoes with septations

Question 12

how does a hematoma appear sonographically in the scrotum?

Answer 12

heterogeneous areas within scrotum

more complex

avascular

displacement of testes

heterogeneous

Question 13

What is epididymitis?

Answer 13

infection

spread of lower UTI or STD via spermatic cord

most common cause of acute scrotal pain in adults

Question 14

What are the clinical symptoms of epididymitis?

Answer 14

scrotal pain for 1-2 days

fever

urethral discharge

scrotal wall edema

most common cause of acute scrotal pain in adults

Question 15

how does epididymitis appear sonographically?

Answer 15

enlarged hypoechoic gland

increased flow

increased velocities in systole and diastole

low resistance wave form

hydrocele

see slide 72-77for picture

Question 16

What is orchitis?

Answer 16

once infection (epididymitis) has spread to the testicle

also associated with hydrocele and pyocele

hyperemic flow

Question 17

what is hyperemic flow?

Answer 17

increase color doppler

Question 18

Excessive swelling can cause ____________to the testicular ________ supply

Answer 18

obstruction

blood

Question 19

what might occur with orchitis?

Answer 19

infarction

Question 20

When does torsion typically occur?

Answer 20

during adolescence 12-18

Question 21

what is the most common etiology for testicular torsion?

Answer 21

anomaly - Bell Clapper Deformity

Question 22

What is the bell clapper deformity?

Answer 22

etiology for torsion

tunica vaginalis completely surround the testis, epididymis and distal spermatic cord causing a twisting

60% anatomic anomaly on both sides

Question 23

What kind of testes is 10x more affected for torsion?

Answer 23

undescended testes

Question 24

What structure is involved in torsion?

Answer 24

spermatic cord

Question 25

What happens to blood flow with torsion?

Answer 25

compromised blood flow venous flow with occluded veins - will happen first arterial flow obstruction leads to ischemia

Question 26

What symptoms present with torsion of spermatic cord?

Answer 26

true emergency **sudden**onset of acute pain swelling nausea and vomiting

Question 27

How soon do you need to surgically fix torsion to save the testicle?

Answer 27

5-6 hrs 100% 6-12 hrs 70% beyond 12 hrs 20%

Question 28

What will the testicle look like if it's torsed?

Answer 28

after 4-6 hrs testis swollen hypoechoic After 24 hrs - heterogenous Scrotal thickening and hydrocele

Question 29

What is torsion of the testicular appendages?

Answer 29

"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

Question 30

What is an epididymal cyst? (aka: extra testicular masses)

Answer 30

benign fluid collection typical cyst criteria

Question 31

What is a spermatocele?

Answer 31

extra testicular mass cystic dilation of the efferent duct of the epididymis

Question 32

where would a spermatocele be found?

Answer 32

located in the epi head ***seen often following a vasectomy*** contain proteinaceous fluid and spermatozoa

Question 33

What is a varicocele?

Answer 33

abnormal dilation of the veins of the PAMPINIFORM plexus within the spermatic cord

Question 34

what side is is often associated with varicocele?

Answer 34

more common on the Left because of the left renal vein

Question 35

What causes a varicocele?

Answer 35

incompetent valves in the spermatic vein pressure from renal hydronephrosis, mass, liver cirrhosis

Question 36

What is associated with infertility - most common and correctible?

Answer 36

varicocele see slide 102+ for images

Question 37

what do you have the patient do to prove varicocele?

Answer 37

valsalva

Question 38

What is a pyocele?

Answer 38

pus filled abscess

Question 39

What is a hematocele?

Answer 39

blood - trauma

Question 40

what is hydrocele?

Answer 40

serous fluid - swelling

Question 41

What is a tubular ectasia of the rete testis?

Answer 41

benign mass Assoc with epididymial obstruction due to trauma or inflammation Cystic lesion in mediastinum testis Bilateral asymmetry

Question 42

what is microlithiasis?

Answer 42

tiny calcifications in the testicle multiple (two or three is not really microlithiasis)

Question 43

What is associated with microlithiasis?

Answer 43

cryptorchidism (undescended testis) infertility klinefelter's (genetic) varicocele

Question 44

What is a seminoma?

Answer 44

malignant mass **most common malignancy of the testicle*** cryptorchidism painless scrotal mass solid, hypoechoic nodule

Question 45

What are the risk factors for seminoma?

Answer 45

Family history Cryptorchidism Down's syndrome Smoking Infertility White race

Question 46

What is a germ cell tumor?

Answer 46

non seminoma Spread more quickly High levels of serum Alpha feta protein Teratoma - infants Choriocarcinoma - elevated hCG Embryonal cell

Question 47

What is a leydig cell tumor?

Answer 47

uncommon benign in children malignant in adults non germ cell

Question 48

What is cryptorchidism?

Answer 48

undescended testicle

Question 49

where might an undescended testicle be found?

Answer 49

abdomen inguinal canal other location

Question 50

what percent of undescended testicles are found in the inguinal canal?

Answer 50

80% more common in premature babies

Question 51

What is an orchiopexy?

Answer 51

surgically bringing down of the testicle

Question 52

What is a scrotal hernia (inguinal)?

Answer 52

bowel (most common) omentum or other structures into the scrotum look for peristalsis of the bowel

Question 53

What is an indirect hernia? finish slide 130

Answer 53

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

Question 54

What is a direct hernia? finish slide 131

Answer 54

acquired occurs when a weak spot develops in the lower abd musculature due to lifting heavy objects, coughing, straining, pregnancy, constipation lower