Scrotal Pathology (Powerpoints and Book) Flashcards
What is the normal size of the testis?
3-5 cm Long
2-3 cm AP 2-3 cm wide.
How long is the epididymis?
20 feet long but since it is coiled it is 3.8cm long.
What is the largest portion of the epididymis?
head.
Fluid between the layers of tunica vaginalis
hydrocele
What is the cause of hydroceles?
unknown but can be caused from trauma, infection, infarction, torsion, and testicular neoplasms.
What are hydroceles often associated with?
orchitits or epididymitis
If the hydrocele is very large and the testicle is hard to image, what can we do to better see?
lower the frequency and used a curvilinear probe.
blood between layers of tunica vaginalis
hematocele
Can hematoceles become complex over time? Do they have blood flow?
no blood flow, and yes they can become complex over time with cystic areas and septations
Where are spermatoceles often found and what are they?
it is a dilation of ductules and is mostly found in the head of the epi
Where are epididymal cysts often found?
anywhere in the epi
What do spermatoceles and epidiymal cysts have in common?
both are simple or loculated, low level echoes and have posterior enhancement.
What is the clinical findings of spermatocelesand epi cysts?
palpable mass and if larger can cause generalized painless scrotal enlargement
Nearly all extratesticular masses are benign.
T/F
true
i cysts are often multiple and spermatoceles tend to be solitary
t/f
true
What are variococeles
Which side are they most common on and why?
Varicoceles are dilation of venous pampiniform plexus (bundle of veins)
is more common on the left because the left testicular vein is longer and enters the left renal vein at a right angle
What can variococeles be caused by and what types of patients are at risk?
caused by incompetent valve, trauma, bearing down, or mass pressing on vessel.
Cirrhotic patients are more at risk (kinda similar to portal hypertension)
With the valsalva technique, how wide should the vessels be to be considered varioceles.
2 mm
What can we do prove it is a variocele?
put color on and perform the valsalva technique.
Are patients with varicoceles more at risk for infertility?
yes
calcifications within the peritesticular space that can often be palpated.
Scrotal Pearls…
What are scrotal pearls associated with?
torsion, epididymitis, inflammation, and hydrocele
What is a pyocele and what is it commonly associated with?
Clinical symptoms?
collection of peritesticular pus, often in patients with inflammatory scrotal conditions or scrotal trauma
presents with redness, pain, warmth, elevated WBC and low grade fever.
Scrotal pearls are highly echogenic and often seen with a hydrocele.
T/F
true
How can we prove scrotal hernia?
with peristalsis and movement in and out of the scrotal sac.
it is really important to scan very laterally to appreciate the hernia.
True
What will help diagnose the scrotal hernia?
valsalva the patient. The hernia will shoot into the scrotal sac
What are the clinical indications for scrotal hernia?
swollen scrotum, palpable mass, and painful if there is no blood flow
What will a scrotal hernia look like on US?
fluid, complex depending on contents, peristalsing, and movement of bowel with Valsalva.
What is the most common cause of scrotal pain in adults?
infections from UTI’s, mumps, syphilis, TB, trauma, or chemicals.
What accounts for most acute inflammatory diseases of the scrotum?
Epididymitis
What are some clinical findings for epididymitis? (think infection)
excruciating pain, painful swelling, redness, skin warmth and thickening. Increased WBC
What will epididymitits look like on ultrasound?
hypoechoic, enlarged epi, hydrocele, increased blood flow.
20% look normal.
Orchitis is the inflammation of the _____.
testis.
Orchitis occurs as progression into testicle of untreated epididymitis
T.F?
true
What will orchitis look like on US?
enlarged testicle, hypoechoic, increased blood flow, swelling, reversed diastolic flow, hydrocele, wall thickening.
when the spermatic cord twists and testicle rotates.
testicular torsion.
What are the clinical indications for torsion?
sudden or severe pain and sometimes nausea and vomiting.
Young adults with ____ _____ anomaly are associated with testicular torsion.
Bell-Clapper (when testicle is suspended within hemiscrotum by a stalk of spermatic cord.
What is the salvage for:
5-6 hours
6-12 hours
24+ hours
5-6 hours-80%-100%’
6-12 hours- 70%
+24 hours-20%
Sonographically, torsion reveals enlarged hypoechoic testi with a ______ sign, hydro and an enlarged epi.
whirl pool sign
donut shaped with color
What is cryptorchidism and where is it often found?
undecended testicles
in the inguinal canal.
What pathologies is often associated with cryptorchidism?
infertility, cancer, and scrotal hernia.
When cancers metastasizes to the testicles, where does it usually originate from?
prostate or kidney
but can also come from lung, pancreas, bladder colon, thyroid and melanoma
What will METS of testicle look like on US?
solid, hypoechoic complex. Put on color, it will light up like a christmas tree.
Most solid intratesticular masses are malignant and germ cell in origin.
t/f
true.
What is the most common germ cell tumor account for half the tumors?
seminoma.
If a patient has a palpable mass on his testicle and it is very hard, this is suspicious of ______.
malignancy.
Seminomas often metastasize to ____ ____.
lymph nodes
What will seminomas look like on US?
hypoechoic homogenous, unilateral, variable in size and have microlithiasis.
bright, non-shadowing foci in the testicle
microlithiasis
Microlithasis often measures less than ____
3 mmm
Microlithasisis is often bilateral and more than 5 per image is questionable for malignancy
t/f
TRUE.
What age range is Embryonal cell carcinoma often seen in?
20-40 year olds.
Seminomas are more agressive then embryonal cell CA
t/f
False
embryonal cell CA is more agressive.
What will an embryonal cell CA look like on US?
hypoechoic, and disorting the borders of testicle
Teratomas are often seen iun white age range?
25-35 year olds, prepubertal and neonates
When seen in older patients, teratomas are often ____ .
malignant or benign
malignant.
What is the rarest germ cell tumor and what age range are they seen?
choriocarcinoma
10-30 years old.
Patients with choriocarcinoma have an elevated_____ lab value.
HCG
What is the most common non-germ cell cancer of the testi, and what is the age range?
Malignant leydig cell tumor
3rd through 6th decade of life.
What will a leydig cell tumor look like on US and what does it produce?
solid intratesticular mass and is hypoechoic with cystic areas
produces estrogen or testosterone.
What is the age range of sertoli cell tumors?
any age
