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Case Studies > Scrotal Pathology (Powerpoints and Book) > Flashcards

Scrotal Pathology (Powerpoints and Book) Flashcards

1
Q

What is the normal size of the testis?

A

3-5 cm Long

2-3 cm AP 2-3 cm wide.

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2
Q

How long is the epididymis?

A

20 feet long but since it is coiled it is 3.8cm long.

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3
Q

What is the largest portion of the epididymis?

A

head.

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4
Q

Fluid between the layers of tunica vaginalis

A

hydrocele

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5
Q

What is the cause of hydroceles?

A

unknown but can be caused from trauma, infection, infarction, torsion, and testicular neoplasms.

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6
Q

What are hydroceles often associated with?

A

orchitits or epididymitis

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7
Q

If the hydrocele is very large and the testicle is hard to image, what can we do to better see?

A

lower the frequency and used a curvilinear probe.

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8
Q

blood between layers of tunica vaginalis

A

hematocele

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9
Q

Can hematoceles become complex over time? Do they have blood flow?

A

no blood flow, and yes they can become complex over time with cystic areas and septations

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10
Q

Where are spermatoceles often found and what are they?

A

it is a dilation of ductules and is mostly found in the head of the epi

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11
Q

Where are epididymal cysts often found?

A

anywhere in the epi

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12
Q

What do spermatoceles and epidiymal cysts have in common?

A

both are simple or loculated, low level echoes and have posterior enhancement.

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13
Q

What is the clinical findings of spermatocelesand epi cysts?

A

palpable mass and if larger can cause generalized painless scrotal enlargement

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14
Q

Nearly all extratesticular masses are benign.

T/F

A

true

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15
Q

i cysts are often multiple and spermatoceles tend to be solitary

t/f

A

true

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16
Q

What are variococeles

Which side are they most common on and why?

A

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

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17
Q

What can variococeles be caused by and what types of patients are at risk?

A

caused by incompetent valve, trauma, bearing down, or mass pressing on vessel.

Cirrhotic patients are more at risk (kinda similar to portal hypertension)

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18
Q

With the valsalva technique, how wide should the vessels be to be considered varioceles.

A

2 mm

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19
Q

What can we do prove it is a variocele?

A

put color on and perform the valsalva technique.

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20
Q

Are patients with varicoceles more at risk for infertility?

A

yes

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21
Q

calcifications within the peritesticular space that can often be palpated.

A

Scrotal Pearls…

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22
Q

What are scrotal pearls associated with?

A

torsion, epididymitis, inflammation, and hydrocele

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23
Q

What is a pyocele and what is it commonly associated with?

Clinical symptoms?

A

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.

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24
Q

Scrotal pearls are highly echogenic and often seen with a hydrocele.

T/F

A

true

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25
Q

How can we prove scrotal hernia?

A

with peristalsis and movement in and out of the scrotal sac.

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26
Q

it is really important to scan very laterally to appreciate the hernia.

A

True

27
Q

What will help diagnose the scrotal hernia?

A

valsalva the patient. The hernia will shoot into the scrotal sac

28
Q

What are the clinical indications for scrotal hernia?

A

swollen scrotum, palpable mass, and painful if there is no blood flow

29
Q

What will a scrotal hernia look like on US?

A

fluid, complex depending on contents, peristalsing, and movement of bowel with Valsalva.

30
Q

What is the most common cause of scrotal pain in adults?

A

infections from UTI’s, mumps, syphilis, TB, trauma, or chemicals.

31
Q

What accounts for most acute inflammatory diseases of the scrotum?

A

Epididymitis

32
Q

What are some clinical findings for epididymitis? (think infection)

A

excruciating pain, painful swelling, redness, skin warmth and thickening. Increased WBC

33
Q

What will epididymitits look like on ultrasound?

A

hypoechoic, enlarged epi, hydrocele, increased blood flow.

20% look normal.

34
Q

Orchitis is the inflammation of the _____.

A

testis.

35
Q

Orchitis occurs as progression into testicle of untreated epididymitis

T.F?

A

true

36
Q

What will orchitis look like on US?

A

enlarged testicle, hypoechoic, increased blood flow, swelling, reversed diastolic flow, hydrocele, wall thickening.

37
Q

when the spermatic cord twists and testicle rotates.

A

testicular torsion.

38
Q

What are the clinical indications for torsion?

A

sudden or severe pain and sometimes nausea and vomiting.

39
Q

Young adults with ____ _____ anomaly are associated with testicular torsion.

A

Bell-Clapper (when testicle is suspended within hemiscrotum by a stalk of spermatic cord.

40
Q

What is the salvage for:

5-6 hours

6-12 hours

24+ hours

A

5-6 hours-80%-100%’

6-12 hours- 70%

+24 hours-20%

41
Q

Sonographically, torsion reveals enlarged hypoechoic testi with a ______ sign, hydro and an enlarged epi.

A

whirl pool sign

donut shaped with color

42
Q

What is cryptorchidism and where is it often found?

A

undecended testicles

in the inguinal canal.

43
Q

What pathologies is often associated with cryptorchidism?

A

infertility, cancer, and scrotal hernia.

44
Q

When cancers metastasizes to the testicles, where does it usually originate from?

A

prostate or kidney

but can also come from lung, pancreas, bladder colon, thyroid and melanoma

45
Q

What will METS of testicle look like on US?

A

solid, hypoechoic complex. Put on color, it will light up like a christmas tree.

46
Q

Most solid intratesticular masses are malignant and germ cell in origin.

t/f

A

true.

47
Q

What is the most common germ cell tumor account for half the tumors?

A

seminoma.

48
Q

If a patient has a palpable mass on his testicle and it is very hard, this is suspicious of ______.

A

malignancy.

49
Q

Seminomas often metastasize to ____ ____.

A

lymph nodes

50
Q

What will seminomas look like on US?

A

hypoechoic homogenous, unilateral, variable in size and have microlithiasis.

51
Q

bright, non-shadowing foci in the testicle

A

microlithiasis

52
Q

Microlithasis often measures less than ____

A

3 mmm

53
Q

Microlithasisis is often bilateral and more than 5 per image is questionable for malignancy

t/f

A

TRUE.

54
Q

What age range is Embryonal cell carcinoma often seen in?

A

20-40 year olds.

55
Q

Seminomas are more agressive then embryonal cell CA

t/f

A

False

embryonal cell CA is more agressive.

56
Q

What will an embryonal cell CA look like on US?

A

hypoechoic, and disorting the borders of testicle

57
Q

Teratomas are often seen iun white age range?

A

25-35 year olds, prepubertal and neonates

58
Q

When seen in older patients, teratomas are often ____ .

malignant or benign

A

malignant.

59
Q

What is the rarest germ cell tumor and what age range are they seen?

A

choriocarcinoma

10-30 years old.

60
Q

Patients with choriocarcinoma have an elevated_____ lab value.

A

HCG

61
Q

What is the most common non-germ cell cancer of the testi, and what is the age range?

A

Malignant leydig cell tumor

3rd through 6th decade of life.

62
Q

What will a leydig cell tumor look like on US and what does it produce?

A

solid intratesticular mass and is hypoechoic with cystic areas

produces estrogen or testosterone.

63
Q

What is the age range of sertoli cell tumors?

A

any age

Case Studies (14 decks)

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