Scrotal Powerpoint Flashcards
Scrotum
skin pouch, supports the testes outside the body for survival of sperm
Divided by a septum into 2 compartments
Each compartment contains a testis, epididymis, spermatic cord and ductus deferens.
Testes
2 male reproductive glands, produces sperm and testosterone
Size 3-5 cm in length
3cm in height
3x3x5
Seminal vesicles
2 sac-like structures located posterior to the bladder, store sperm
Tunica albuginea
Dense fibrous capsule surrounding the testes
Tunica vaginales
2 serous layers covering the testes
A potential space between the 2 layers exists for a hydrocele to form
Septal raphe
fibrous tissue dividing the scrotum into 2 separate compartments
prevents infections on one side from passing to the opposite testicle
Mediastinum testes
a vertical septum which provides support for the testicular vessels and ducts to enter and exit
Epididymis
elongated structure along the posterolateral aspect of the testis
Head,body,tail
Stores sperm
Appendix testis
seen in 80% of patients, a small oval structure on the superior pole, remnant of the mullerian duct
Pampiniform plexus
plexus of veins in the spermatic cord that drain into the right and left testicular veins; when a varicocele is present, dilatation and tortuosity may develop
Spermatic cord
structure made up of the vas deferens, testicular artery,cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum
SONOGRAPHICALLY TESTE IS
SMOOTH, MEDIUM GRAY STRUCTURE WITH FINE ECHOTEXTURE
Normal Rete Testies
THE AREA IN THE TESTIS WHERE THE SEMINIFEROUS TUBULES CONVERGE BEFORE DRAINING IN THE HEAD OF THE EPIDIDYMIS
Normal Mediastinum Testis- Transverse Image
THE VERTICAL SEPTUM IN THE TESTIS FORMED BY THE MULTIPLE FOLDS OF DENSE, FIBROUS TISSUE THAT COMPLETELY COVERS THE TESTE KNOWN AS THE TUNICA ALBUGINEA
Normal Mediastinum Testis- Sagital Image
HELPS TO SUPPORT THE VESSELS & DUCTS THAT COURSE THRU THE TESTES
SEEN ON US AS A BRIGHT, HYPERECHOIC LINE
Normal Septal Raphe- Transverse Image
THIS FIBROUS TISSUE IS A MIDLINE STRUCTURE THAT CAN BE MISTAKEN BY THE PATIENT AS A NEW “PALPABLE NODULE”
Normal Appendix Testis
A SMALL STRUCTURE ATTACHED TO THE UPPER POLE LOCATED BETWEEN THE TESTE AND EPIDIDYMIS
90% UNILATERAL OCCURANCE RATE
NOT TO BE CONFUSED WITH THE EPIDIDYMIS HEAD
IT IS ISOECHOIC WITH THE TESTE AND IS BEST SEEN WITH A HYDROCELE
Appendix Epididymis
IS A SMALL PROTUBANCE FROM THE EPI HEAD WITH ONLY A 34% OCCURANCE RATE
Epididymis location and size
beginning superiorly and then coursing posterolater to the test
is 6 to 7 cm
Epididymis Head- measurement and location
largest part
6 to 15 mm in width
superior to upper pole of testis
Normal Epididymis Appearence
isoechoic or hypoechoic compared with the testis, although the echo texture is coarser
SHOULD BE IMAGED ON ALL SCROTAL US EXAMS IN LONG AND TRANS PLANES
Epididymis Head ductules
CONTAINS 10-15 DUCTULES COMING FROM THE RETE TESTE TO FORM A SINGLE DUCT IN THE HEAD & BODY OF THE EPIDIDYMIS
BODY OF EPIDIDYMIS
COURSES ALONG THE POSTEROLATERAL ASPECT OF THE TESTE-SMALLER THAN THE HEAD AND TAIL
DIFFUCULT TO IMAGE WHEN NORMAL
Tail of Epididymis
POSTERIOR TO THE LOWER POLE OF THE TESTE
Body and Tail of Epididymis
BOTH STRUCTURES CONTAIN A SINGLE DUCT KNOWN AS THE DUCTUS EPIDIDYMIS WHICH BECOMES THE VAS DEFERENS IN THE SPERMATIC CORD
Blood Supply- Testicular Arteries
primary blood supply, arise from the abd aorta below the level of the renal arteries
Blood Supply- Testicular Arteries Doppler
Normal Doppler signals are low velocity, low resitive flow
Helpful in determing torsion or tumor vascularity
Power doppler may also be helpful.
Arterial Vessels of the Teste
AORTA—TESTICULAR ARTERY—CAPSULAR ARTERY—CENTRIPETAL ARTERY—RECURRENT RAMI
50% of men have a
TRANSMEDIASTINAL ARTERY (& ACCOMPANYING VEIN) THAT COURSES THRU THE MEDIASTINUM TOWARDS THE TESTIS CASPSULE
COLOR FLOW IN THE TMA WILL BE
OPPOSITE OF THE CENTRIPETAL ARTERIES
FLOW IN THE CMA IS _____ FROM THE MEDIASTINUM
away
FLOW IN THE CENTRIPETAL ARTERIES IS ______ THE MEDIASTINUM
towards
Normal Color demonstrates
BLOOD FLOW IN CENTRIPETAL ARTERIES
Spectral Doppler demonstrates
NORMAL LOW-RESISTANCE WAVEFORM
Resistive Index
PEAK SYSTOLE MINUS PEAK DIASTOLE DIVIDED BY PEAK SYSTOLE (S-D/S=RI
RI values
WILL DIFFER SLIGHTLY DEPENDING ON THE ORGAN
AVERAGE RANGE IS BETWEEN 0.4-0.8
HIGHER VALUES INDICATE DECREASED PERFUSION
ARTERIES WITH LOW-RESISTIVE (LOW IMPEDANCE) BLOOD FLOW SUPPLY
ORGANS THAT NEED CONTINUOUS PERFUSION (LIVER, KIDNEYS, TESTES, UMBILICAL CORD)
Testis Benign Pathology- Tubular Ectasia Of the Rete Testes
> age 45
Testis Benign Pathology- Intratesticular
located near mediastinum testis
Testis Benign Pathology- Abscess
normally from epidiymo-orchitis
Testis Benign Pathology- Hydrocele
an abnormal accumulation of serous fluid between the layers of the tunica vaginalis
Most common cause of painless scrotal swelling
Congenital or acquired (trauma,epididymitis,or torsion)
Testis Benign Pathology- Henatoceles
trauma,surgery,torsion,diabetes, or arterosclerosis
Testis Benign Pathology- Pyoceles
occurs when an abscess ruptures into an existing hydrocele
Normally have septations or scrotal skin thickening
Testis Benign Pathology- Varioceles
enlargement of the veins of the spermatic cord most commonly left side
< 25 years of age
Hydrocele is associated with
neoplasms, tends to be smaller
Is it normal for a small amount of hydrocele to excist?
Yes
