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Summer 2014 - High Resolution ✔️ > Scrotum > Flashcards

Scrotum Flashcards

0
Q

what are the parts of the scrotum

A

testes, epididymis, and spermatic cord

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1
Q

what is the scrotum

A

supporting structure for the testes that allows for sperm survival

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2
Q

the testicles form part of the male reproductive organs, with a primary function of producing ______ and the male hormone ______

A

sperm

testosterone

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3
Q

US imaging is the modality of choice for scrotum…what is used during the exam

A

high frequency
doppler
improved spatial and contrast resolution
color doppler adds increased sensitivity to display scrotal perfusion

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4
Q

describe the testes

A 
resides in scrotum
symmetric
oval gland
exocrine gland - spermatozoa
endocrine gland - testosterone
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5
Q

normal testes measurement

A

3-5 cm length x 3 cm AP x 2-4 cm wide

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6
Q

conical lobules contain _________ tubules

A

seminiferous

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7
Q

scrotum is divided by the _____ _____

A

median raphe

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8
Q

tubules converge to form the network of channels…

______ drains into the head of the epididymis in the ______ where the mediastinum resides

A

rete testis

hilum

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9
Q

sperm cells are formed in which 6 locations

A 
seminiferous tubules
tubuli recti
rete testis
efferent ductules
ductus epididymis
vas deferens
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10
Q

describe the epididymis

A

6-7 cm
tubular structure
posterior and superior
head, body, tail

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11
Q

describe epididymis head

A

superior to the upper pole

6-15 mm

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12
Q

what is the job of the epididymis

A

store and transport sperm (through head, body, tail)

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13
Q

describe ductus epididymis

A

single duct in body and tail

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14
Q

describe vas deferens

A

continues in spermatic cord

transports sperm to the seminal vesicles

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15
Q

what are seminal vesicles

A

contains fluid for sperm

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16
Q

ductus (vas) deferens is surgically interrupted during a ________

A

vasectomy

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17
Q

the ________ or ________ gland secretes fluid

A

bulbourethral or cowper

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18
Q

describe appendix testis

A

remnant of the mullerian duct - ovoid structure beneath the head of the epididymis

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19
Q

know part of the testis on slide 18

A

study it !!

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20
Q

describe the tunica albuginea

A

dense, fibrous tissue, completely covers testes

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21
Q

describe mediastinum testis

A

posterior aspect of multiple septation reflects into testis

linear stripe of variable thickness running through the testis in a craniocaudal direction

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22
Q

describe the tunica vaginalis

A

serous covering of testis which is a double layer extension of peritoneum

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23
Q

where do hydroceles form

important

A

parietal (outer) and visceral (inner) of the tunica vaginalis

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24
Q

describe the vas deferens

A

thin muscular tubes that carry sperm from each testicle to the urethra

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25
Q

what is the job of the urethra

A

courses from bladder to end of penis

transports both urine and semen

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26
Q

what is a verumontanum

A

junction of the ejaculatory duct with the urethra

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27
Q

describe spermatic cord

A 
vas deferens
testicular arteries
venous pampiniform plexus
lymphatics
autonomic nerves
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28
Q

what arteries arise from the anterior AO just inferior to RA - laterally - low resistance flow

A

right and left testicular arteries

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29
Q

describe the right and left testicular arteries

A

primary source of blood flow
descend in retroperitoneum
enter spermatic cord
pierce albuginea forming capsular arteries

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30
Q

what is the order of the vascular supply of the testicles

A

testicular arteries –> capsular artery –> centripetal artery –> recurrent rami (centrifugal artery)

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31
Q

what supplies the extratesticular

A

cremateric and deferential

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32
Q

venous drainage is from where

A

pampiniform plexus

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33
Q

_____ _____ exits the mediastinum courses through the spermatic cord

A

pampiniform plexus

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34
Q

what 3 veins converge to form the pampiniform plexus

A

testicular, deferential, and cremasteric

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35
Q

right testicular vein drains into the _____

important

A

IVC

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36
Q

left testicular vein drains into the _____

important

A

LRV

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37
Q

clinical findings for scanning a scrotum

A 
palpable mass
scrotal pain
swollen scrotum
trauma
inferility
location / duration
38
Q

review protocol for scrotum

A

slide 40-44

39
Q

at least one image needs to be taken of what???

A

BOTH testes at the same time for comparison

40
Q

what are color/power doppler parameters

A

gain - amplify color
PRF - scale - sets Nyguist limit - reduced for slow flow
wall filter - decrease to enhance flow sensitivity
line density
threshold - color priority
packet size
color box size

41
Q

what is done if there is trauma to the scrotum

A

challenge due to pain and swelling
determine rupture
surgery within 72 hrs - 90% saved

42
Q

what are some complications of trauma to the scrotum

A

hydrocele and hematocele

hematoma - avascular - no doppler

43
Q

most important goal of US in testicular trauma is to determine if a ______ has occured

A

rupture

44
Q

_______ _______ are a surgical emergency requiring a prompt diagnosis

A

ruptured testis

45
Q

if surgery is performed with 72 hrs after injury, up to ____% of testes can be saved, but on _____% can be saved after 72 hrs

A

90%

45%

46
Q

testicular trauma sonographically

A

irregular testicular contour
scrotal wall thickening
hematocele

47
Q

describe a hydrocele

A

fluid formed between the visceral and parietal layers of the tunica vaginalis

48
Q

what technique can easily demonstrate a hydrocele

A

shining a flashlight through the enlarged portion of the scrotum, if the scrotum is full of clear fluid, it will light up

transillumination

49
Q

describe a hematocele

A

blood between visceral and parietal vaginalis

low level echos

caused by bleeding of pampiniform plexus or other extratesticular structure - does not confirm rupture

50
Q

hematoceles sonographically

A

acute - echogenic with echoes

over time - low level echoes with septations

51
Q

describe a hematoma

A

collection of blood

heterogeneous areas within scrotum, more complex, avascular

may cause displacement of testis

sonographically - “ARROWHEADS”

52
Q

trauma will cause ______ ______ of the testicular parenchymal pattern and an interruption of the ______ ______

A

focal alteration

tunica albuginea

53
Q

what is epididymitis

A

an infection

spread of lower UTI or STD’s via the spermatic cord

MOST COMMON cause of acute scrotal pain in adults

54
Q

clinical findings of epididymitis

A

scrotal pain for 1-2 days
fever
urethral discharge
scrotal wall edema

55
Q

epididymitis sonographically

A 
enlarged hypoechoic gland
increased flow
increased velocities in systole and diastole
low resistance wave form
hydrocele
56
Q

what is orchitis

A

once the infection has spread to the testicle

associated with hydrocele and pyocele

hyperemic flow - increase color doppler

57
Q

in severe cases of orchitis, ________ ________ may occur and there will be excessive _________

A

testicular infarction

swelling

58
Q

orchitis when dealing with color doppler, spectral doppler, and doppler waveform

A

color doppler - decreased or absent flow compared to other testis

spectral doppler - high resistance with little or no diastolic flow

doppler waveform - reversed diastolic flow

59
Q

what is the MOST COMMON etiology of torsion of the spermatic cord

A

anomaly-bell clapper deformity

60
Q

describe torsion

A

12-18 yrs old

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

60% anatomic anomaly on both sides

undescended testes 10x more affected

61
Q

how does a torsion affect blood flow

A

venous flow with occluded veins

arterial flow obstruction leads to ischemia

62
Q

symptoms of torsion

A

true emergency

sudden onset of acute pain

swelling

nausea and vomiting

63
Q

torsion of spermatic cord survival rate - surgical emergency

5-6 hrs?
6-12 hrs?
beyond 12 hrs?

A

5-6 hrs = 80-100% salvage

6-12 hrs = 70%

beyond 12 hrs = 20%

64
Q

what is the MOST COMMON cause of pain in adolescent boys - peak age 14

A

torsion of spermatic cord

65
Q

how do you doppler a torsed testicle

A

absence of perfusion

detect low flow set PRF and filter low

compare both sides

66
Q

appearance of torsed testicle…

after 4-6 hours
after 24 hrs

A

after 4-6 hrs - swollen and hypoechoic

after 24 hrs - heterogeneous

scrotal thickening and hydrocele

67
Q

what is the sign the doctor see’s of a torsion of a testicular appendage

A

“blue dot” sign

will have focal testicular pain

**most common cause of acute scrotal pain in young boys

68
Q

describe epididymal cysts

A

a cyst is a cyst is a cyst

69
Q

what are spermatoceles

A

cystic dilation of the efferent duct of the epi

70
Q

describe spermatoceles

A

located in the epi head

contain proteinaceous fluid and speratozoa

seen often following vasectomy

71
Q

describe tunica albuginea cysts

A

benign fluid collection

72
Q

what are varicoceles

A

abn dilation of the veins of the pampiniform plexus within the spermatic cord

73
Q

describe a varicocele

A

incompetent valves in the spermatic vein

more common 90% - on LEFT side due to association with left renal vein

could be a result of hydronephrosis, mass, liver cirrhosis

74
Q

what is the MOST COMMON correctable thing that you can fix related to infertiliy

A

varicocele

75
Q

varicocele’s have numerous tubules measuring greater than _____ mm and will increase in response to doing a __________

A

2 mm

valsalva

76
Q

where do hydrocele, pyocele, and hematocele occur

A

potential space between the visceral and parietal layers of tunica vaginalis

77
Q

what is a hydrocele

A

serous fluid - painless swelling

78
Q

what is a pyocele

A

pus filled - abcess

79
Q

what is a hematocele

A

blood filled - trauma

80
Q

describe tubular ectasia of the rete testis

A

benign

uncommon

prominent hypoechoic channels - cluster of cystic areas

avascular (do not confuse with varicocele)

81
Q

describe microlithiasis

A

tiny calcifications in the testicle - echogenic speckles

82
Q

what is microlithiasis associated with

A 
cryptorchidism - undescended testicles 
infertility
Klinefelter's (genetic)
varicocele
malignancy
83
Q

what are malignant masses of the testicles

A

germ cell tumors

seminoma - MOST COMMON malignancy

cryptorchidism - undescended testicles

84
Q

what are seminoma risk factors

A 
cryptorchidism - undescended testicles
family history
infertility
Down syndrome
smoking
white race
85
Q

describe germ cell tumor

A

non seminoma

spread more quickly

high levels of serum

alpha-fetoprotein

86
Q

teratomas are ______ in children and ______ in adults

A

benign

malignant

87
Q

what is leydig cell tumor

A

benign in children

may be malignant in adults

non germ cell tumors

88
Q

describe cryptorchidism

A 
undescended testicles
originates in the retroperitoneum
located in abd, inguinal canal,  or other places
80% palpable in inguinal canal
more common in premature babies
bilateral 10-25%
89
Q

what is the surgical treatment for an undescended testicle

A

orchiopexy

90
Q

what is a scrotal hernia (inguinal)

A

bowel (most common), omentum, or other structures in scrotum

peristalsis of bowel

91
Q

symptoms of scrotal hernia

A

scrotal swelling

pain

blood in stool

92
Q

know indirect and direct hernia’s

A

indirect - congenital lesion with a weakness in the bowel which allows the bowel to go through the internal ring; happens to babies

direct - acquired to due stressing a weakness in the bowel which allows the bowel to go through the abd wall; mid-aged, elderly men

Summer 2014 - High Resolution ✔️ (7 decks)

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