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Breast and Scrotal > Scrotal Powerpoint > Flashcards

Scrotal Powerpoint Flashcards

1
Q

Scrotum

A

skin pouch, supports the testes outside the body for survival of spermDivided by a septum into 2 compartmentsEach compartment contains a testis, epididymis, spermatic cord and ductus deferens.

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2
Q

Testes

A

2 male reproductive glands, produces sperm and testosteroneSize 3-5 cm in length3cm in height 3x3x5

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3
Q

Seminal vesicles

A

2 sac-like structures located posterior to the bladder, store sperm

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4
Q

Tunica albuginea

A

Dense fibrous capsule surrounding the testes

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5
Q

Tunica vaginales

A

2 serous layers covering the testesA potential space between the 2 layers exists for a hydrocele to form

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6
Q

Septal raphe

A

fibrous tissue dividing the scrotum into 2 separate compartmentsprevents infections on one side from passing to the opposite testicle

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7
Q

Mediastinum testes

A

a vertical septum which provides support for the testicular vessels and ducts to enter and exit

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8
Q

Epididymis

A

elongated structure along the posterolateral aspect of the testisHead,body,tailStores sperm

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9
Q

Appendix testis

A

seen in 80% of patients, a small oval structure on the superior pole, remnant of the mullerian duct

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10
Q

Pampiniform plexus

A

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

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11
Q

Spermatic cord

A

structure made up of the vas deferens, testicular artery,cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum

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12
Q

SONOGRAPHICALLY TESTE IS

A

SMOOTH, MEDIUM GRAY STRUCTURE WITH FINE ECHOTEXTURE

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13
Q

Normal Rete Testies

A

THE AREA IN THE TESTIS WHERE THE SEMINIFEROUS TUBULES CONVERGE BEFORE DRAINING IN THE HEAD OF THE EPIDIDYMIS

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14
Q

Normal Mediastinum Testis- Transverse Image

A

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

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15
Q

Normal Mediastinum Testis- Sagital Image

A

HELPS TO SUPPORT THE VESSELS & DUCTS THAT COURSE THRU THE TESTESSEEN ON US AS A BRIGHT, HYPERECHOIC LINE

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16
Q

Normal Septal Raphe- Transverse Image

A

THIS FIBROUS TISSUE IS A MIDLINE STRUCTURE THAT CAN BE MISTAKEN BY THE PATIENT AS A NEW “PALPABLE NODULE”

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17
Q

Normal Appendix Testis

A

A SMALL STRUCTURE ATTACHED TO THE UPPER POLE LOCATED BETWEEN THE TESTE AND EPIDIDYMIS90% UNILATERAL OCCURANCE RATENOT TO BE CONFUSED WITH THE EPIDIDYMIS HEADIT IS ISOECHOIC WITH THE TESTE AND IS BEST SEEN WITH A HYDROCELE

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18
Q

Appendix Epididymis

A

IS A SMALL PROTUBANCE FROM THE EPI HEAD WITH ONLY A 34% OCCURANCE RATE

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19
Q

Epididymis location and size

A

beginning superiorly and then coursing posterolater to the testis 6 to 7 cm

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20
Q

Epididymis Head- measurement and location

A

largest part6 to 15 mm in widthsuperior to upper pole of testis

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21
Q

Normal Epididymis Appearence

A

isoechoic or hypoechoic compared with the testis, although the echo texture is coarserSHOULD BE IMAGED ON ALL SCROTAL US EXAMS IN LONG AND TRANS PLANES

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22
Q

Epididymis Head ductules

A

CONTAINS 10-15 DUCTULES COMING FROM THE RETE TESTE TO FORM A SINGLE DUCT IN THE HEAD & BODY OF THE EPIDIDYMIS

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23
Q

BODY OF EPIDIDYMIS

A

COURSES ALONG THE POSTEROLATERAL ASPECT OF THE TESTE-SMALLER THAN THE HEAD AND TAILDIFFUCULT TO IMAGE WHEN NORMAL

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24
Q

Tail of Epididymis

A

POSTERIOR TO THE LOWER POLE OF THE TESTE

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25
Q

Body and Tail of Epididymis

A

BOTH STRUCTURES CONTAIN A SINGLE DUCT KNOWN AS THE DUCTUS EPIDIDYMIS WHICH BECOMES THE VAS DEFERENS IN THE SPERMATIC CORD

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26
Q

Blood Supply- Testicular Arteries

A

primary blood supply, arise from the abd aorta below the level of the renal arteries

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27
Q

Blood Supply- Testicular Arteries Doppler

A

Normal Doppler signals are low velocity, low resitive flowHelpful in determing torsion or tumor vascularityPower doppler may also be helpful.

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28
Q

Arterial Vessels of the Teste

A

AORTA—TESTICULAR ARTERY—CAPSULAR ARTERY—CENTRIPETAL ARTERY—RECURRENT RAMI

29
Q

50% of men have a

A

TRANSMEDIASTINAL ARTERY (& ACCOMPANYING VEIN) THAT COURSES THRU THE MEDIASTINUM TOWARDS THE TESTIS CASPSULE

30
Q

COLOR FLOW IN THE TMA WILL BE

A

OPPOSITE OF THE CENTRIPETAL ARTERIES

31
Q

FLOW IN THE CMA IS _____ FROM THE MEDIASTINUM

A

away

32
Q

FLOW IN THE CENTRIPETAL ARTERIES IS ______ THE MEDIASTINUM

A

towards

33
Q

Normal Color demonstrates

A

BLOOD FLOW IN CENTRIPETAL ARTERIES

34
Q

Spectral Doppler demonstrates

A

NORMAL LOW-RESISTANCE WAVEFORM

35
Q

Resistive Index

A

PEAK SYSTOLE MINUS PEAK DIASTOLE DIVIDED BY PEAK SYSTOLE (S-D/S=RI

36
Q

RI values

A

WILL DIFFER SLIGHTLY DEPENDING ON THE ORGANAVERAGE RANGE IS BETWEEN 0.4-0.8 HIGHER VALUES INDICATE DECREASED PERFUSION

37
Q

ARTERIES WITH LOW-RESISTIVE (LOW IMPEDANCE) BLOOD FLOW SUPPLY

A

ORGANS THAT NEED CONTINUOUS PERFUSION (LIVER, KIDNEYS, TESTES, UMBILICAL CORD)

38
Q

Testis Benign Pathology- Tubular Ectasia Of the Rete Testes

A

> age 45

39
Q

Testis Benign Pathology- Intratesticular

A

located near mediastinum testis

40
Q

Testis Benign Pathology- Abscess

A

normally from epidiymo-orchitis

41
Q

Testis Benign Pathology- Hydrocele

A

an abnormal accumulation of serous fluid between the layers of the tunica vaginalisMost common cause of painless scrotal swelling Congenital or acquired (trauma,epididymitis,or torsion)

42
Q

Testis Benign Pathology- Henatoceles

A

trauma,surgery,torsion,diabetes, or arterosclerosis

43
Q

Testis Benign Pathology- Pyoceles

A

occurs when an abscess ruptures into an existing hydroceleNormally have septations or scrotal skin thickening

44
Q

Testis Benign Pathology- Varioceles

A

enlargement of the veins of the spermatic cord most commonly left side< 25 years of age

45
Q

Hydrocele is associated with

A

neoplasms, tends to be smaller
Congenital or idiopathic
Usually due to epididymitis

46
Q

Is it normal for a small amount of hydrocele to excist?

A

Yes

47
Q

Hydrocele is seen with

A

orchitis, spermatic cord torsion and trauma

48
Q

Hydrocele

A

collection of serous fluid
most common cause of painless scrotal swelling, anechoic with lower frequency or low dynamic range
infected has internal echoes

49
Q

PRIMARY VARICOCELES

A

CAUSE BY AN ABNORMAL DILATION OF THE VEINS OF THE PAMPINIFORM PLEXUS
ARE CAUSED BY INCOMPETENT VALVES WITHIN THE SPERMATIC VEIN
MORE COMMON ON LEFT DUE TO LSV EMPTING INTO LRV AT A STEEP ANGLE

50
Q

SECONDARY VARICOCELES

A

MORE COMMON IN MEN OVER 40 AND ARE THE RESULT OF RENAL HYDRO, ABD MASS OR LIVER CIRRHOSIS (as the result of portal hypertension)

51
Q

Infections- Orchitis

A

inflammation of the testis

52
Q

Infections- Chlamydia

A

most common cause

53
Q

Infections: Epididymo-Orchitis

A

infection of epididmyitis and testis
most commonly results form the spread of lower urinary tract infection via the spermatic cord
abscess can occur

54
Q

EPIDIDYMITIS

A

Common cause is from the spread of a lower urinary tract infection down the spermatic cord and is the most common cause of acute scrotal pain in adults
Pt has increasing pain over several days, fever and often a urethral discharge (from an untreated UTI)
Spread to the testis occurs in about 1/3 of the cases

55
Q

EPIDIDYMAL CYSTS

A

small, anechoic structures filled with serous fluid found anywhere in the epididymis

56
Q

SPERMATOCELE

A

CYSTIC DILATATIONS OF THE EFFERENT DUCTULES OF THE EPIDIDYMIS
ALWAYS LOCATED IN EPIDIDYMAL HEAD
FLUID CONTAINS PROTEIN AND SPERMATOZOA
MORE COMMON IN VASECTOMY PATIENTS
US CANNOT RELIABLY DIFFERENTIATE BETWEEN EPIDIYMAL CYSTS & SPERMATOCELES
SPERMATOCELES CAN APPEAR AS SIMPLE CYSTS, WITHOUT DEBRIS & SEPTATIONS

57
Q

Microlithiasis

A

Small bilateral calcifications < 3mm ( so normally, do not shadow)
Associated with cryptorchidism, Klinefelters syndrome (extra x chromosome) infertility, testicular atrophy. Also assocatied with malignancy. Annual sonography is suggested

58
Q

Cryptorchididsm

A

Undescended testis
most common GU anomaly in male infants.
Infertility and cancer are 2 potential complications.
Undescended testis will be smaller with decreased echogenicity as compared to contralateral normal testis.
80% found in inguinal canal
often in preemies
higher risk for torsion and cancer

59
Q

Scrotal hernia

A

Occur when bowel, omentum, or other structures herniate into the scrotum
Bowel is most commonly herniated structure, followed by omentum
Peristalsis of bowel seen with real time
Usually a clinical diagnosis
Omentum will be echogenic due to fat

60
Q

Trauma

A 
Rapid assessment
Marked scrotal pain, swelling
Vascular disruption
Fracture/rupture
Surgical emergency
If surgery performed within 72 hours after injury, up to 90% of testes can be saved
Only 45% can be saved after 72 hours
61
Q

FRACTURED TESTIS

A

OCCURS FROM DIRECT BLOW TO TESTIS (MVA/ATHLETIC INJURY)
90% CAN BE SAVED IF SURGICAL TREATMENT OCCURS BEFORE 72 HOUR
BLOOD FLOW WOULD BE ABSENT IN AREA OF IRREGULAR TESTIS PARENCHYMA
NOTE THE SIMILAR APPEARANCE OF FRACTURED AREA TO TESTIS WITH LATE STATE TORSION

62
Q

EARLY TORSION

A

RT TESTIS IS SWOLLEN WITH MILDLY HETEROGENOUS ECHOCTEXTURE-THOUGH TESTICULAR ECHOGENCITY REMAINS SIMILAR TO UNAFFECTED SIDE
TORSION OCCURS FROM BELL CLAPPER DEFORMITY (tunica vaginalis completely surrounds the testis, epididymis and distal spermatic cord lacking the bare area along the posterior scrotal wall)

63
Q

LATE TORSION

A

RT TESTIS IS NOW HYPOECHOIC & SWOLLEN INDICATING TESTICULAR ISCHEMIA
(IN TORSION, VENOUS FLOW IS AFFECTED FIRST CAUSING OCCLUDED VEINS, FOLLOWED BY ARTERIAL OBSTRUCTION-ONCE ARTERIAL FLOW CEASES TISSUE NECROSIS OCCURS AND AFFECTED ORGANS BECOME HYPOECHOIC IN APPEARANCE)

64
Q

Torsion

A

Bare area not present, the tunica vaginalis completely surrounds the testis, epididymis, and distal spermatic cord, allowing them to move and rotate freely within the scrotum
Bell Clapper anomaly
Surgical emergency, if surg within 5 to 6 hours of the onset of pain 80-100% of testes can be salvaged
Between 6-12 hours, 70% after 12 hours, only 20% can be saved
Most common cause of acute scrotal pain in adolescents, can occur at any age but peaks at age 14
Severe pain can cause nausea and vomitting
Torsion of the appendix epididymis and appendix testes can also occur

65
Q

Malignant masses

A

Germ cell and non germ cell
95% are germ cell, elevated hCG and AFP
Most common seminoma, then embryonal cell tumors and teratocarcinomas
Most frequently between 20 and 34 years of age
Extratesticular masses usually benign, intratesticular masses usually malignant

66
Q

Seminoma

A

most common

67
Q

Metastasis

A

Rare to the testicle
Normally occurs late in life and is bilateral with multiple lesions
Primary tumor may originate from prostate or kidneys; less common sites include lung, pancreas, bladder, colon, thyroid or melanoma

68
Q

Lymphoma

A

Malignant lymphoma makes up 1-7% of all testicular tumors

69
Q

Leukemia

A

Leukemia involvement of the testicle is most often found in children
In children with leukemia, 8% have been reported to have testicular involvement

Breast and Scrotal (5 decks)

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