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scrotum Flashcards

1
Q

At __ weeks of gestation female and male embryo appear identical

A

7-8

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2
Q

•
Testes develop from area near where the ____ develop, and about the same time
•

A

kidneys

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3
Q

____ month the testes descend through inguinal canal into the scrotum
•

A

8th – 9th

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4
Q

________ is the condition when 1 or both testes don’t reach the scrotum. Occasionally a testicle may remain undescended and will need to be surgically brought down where it will be sutured into the scrotum.

This procedure is called_______.

A

Cryptorchidism

ORCHIOPEXY

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5
Q

Between the 3rd and 9th month of pregnancy the testes descend from the____ area (medial to the mesonephros, remember this tissue? It is the second fetal kidney) into the future scrotum. The descend is due to a combination of ______________.

A

lumbar

growth processes and hormonal influences

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6
Q

The_______ also plays a decisive role in testis descent. When does it develop?

Cranially it has its origin at the testis and inserts in the region of the genital swelling (future scrotum).
At the same time, at the inguinal canal along the lower gubernaculum, an evagination of the peritoneum arises, the vaginal process, on which the testes will slide through the inguinal canal.

A

gubernaculum testis

IT develops in the 7th week from the lower gubernaculum, after the mesonephros has atrophied.

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7
Q

testicular development at 2 months. label.

A
  1. Gubernaculum testis 2. Penis 3. Inguinal canal
  2. Testis 5. Peritoneal cavity 6. Deferent duct
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8
Q

what is the arrow pointing to?

A

parietal peritoneal lining. (it pulls the lining down as it descends)

In this diagram, the beginning of the formation of the vaginal process is visible. It enters with the testis into the inguinal canal. Shown in blue is the gubernaculum that becomes increasingly shorter.

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9
Q

Between the____ and ____ month of pregnancy the testes remain near the inguinal canal in order to pass through it. The vaginal process lengthens while the gubernaculum shortens, thereby drawing the testis, the deferent duct and its vessels on both sides downwards

A

3rd and 7th

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10
Q

In the____ month of pregnancy (but also sometimes only after birth) the testes reach the scrotum. The vaginal process forms now a serous bilaminar structure on the front side of the testis.

A

9th

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11
Q

serous bilaminar

A

The parietal layer: lines the scrotal sac The visceral layer: surrounds the testicle

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12
Q

serous memebrane

This type of tissue creates a____ in the scrotum or_____ within the abd. of pleural fluid within the thorax.

A

scrotum lining – a serous membrane (or serosa) is a smooth membrane consisting of a thin layer of cells which secrete serous fluid.

hydrocele, ascites

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13
Q

process vaginalis

A

canal created by descent

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14
Q

bare area

A

no visceral tunica vaginalis (lymphatics, nerves, veins and sperm exit this area)

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15
Q

testes are _____ in fetal life.

A

retroperitoneal

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16
Q

scrotum

A

sac of skin continuous w/ the abdomen

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17
Q

•
_____muscles within scrotal wall; controls the contraction of the scrotal skin. The contraction of the skin will drawl the testes closer to the body.

A

Dartos

causes skin to pucker, regulating temperature. autosomal ( we can’t control it) but can be a problem (caused by nerves, temp) you get a lousy image then on US

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18
Q

the scrotum sac is divided into 2 halves by the ____. ____ divides the scrotum into a rt and lt hemishere

A

septum

median raphe

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19
Q

what does each hemiscrotum contain?

A

A testis
An epididymis
A portion of spermatic cord
A vas deferens (ductus deferens) (makes sperm)

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20
Q

what can you see here? why?

A

Median Raphe
•
Scrotal wall is inflamed but the median raphe is clearly seen separating the two hemiscrotums.

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21
Q

notice the lobules in the testes. what do they contain?

A

seminiferous tublues (place sperm is made)

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22
Q

what is the testes endocrine function?

what type of cells are found here?

A

testosterone

Sertoli cells: provide nourishment to the sperm cells
–
Leydig Cells: These cells are in the intestinal space and secrete the male sex hormone testosterone
Cross section of a Seminiferous tubules

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23
Q

what are the testes exocrine functions?

A

spermatozoa (germ cell) via- Seminiferous tubules
–
spermatogonium cells develop into sperm
–
primitive sperms cells are peripheral
–
immature sperm cells at the lumen
–
once in the lumen sperm travel to the epididymis to mature

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24
Q

what is the tete testes

A

–
Within the mediastinum still beneath the tunica albuginea
–
Connects seminiferous tubules to epididymis

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25
Q

what does the epididymis do?

what parts does it have?

A

Store spermatozoa. acts as Transport conduit

Head thickest portion, can be more echogenic than that body
Body is the longest portion
Tail smallest and most inferior

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26
Q

what are teh vas deference aka?

what doe they do?

A

Ductus Deference
–
The excretory duct of the testis
Continuation of the epididymis
Thin muscular tube which transports sperm from the testis to the prostatic urethra

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27
Q

____ serves as a conduit. contains arteries, veins (network called the pampiniform plexus), nerves, lymph vessels

A

spermatic cord

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28
Q

the _____ muscle raises and lowers testes from body. It, along with the scrotal wall muscle the dartos help to control the temperature of the testes.

A

cremaster

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29
Q

what is the out most layer of the testes?

A

fascia

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30
Q

_____ is a vestigial remnant of the Müllerian duct (paramesonephric duct), present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.

A

appendix testis

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31
Q

•
This structure is derived from the Wolffian duct (mesonephric duct) as opposed to the appendix testis which is derived from the Müllerian duct remnant.

A

Appendix testis / appendix epididymis

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32
Q

____ is The hilum of the testis
•
Linear fibrous structure, thicken area of the tunica albuginea (more echogenic fibrous surrounding that holds open the hilum)
•
Each testicle has one
•
Arteries, veins, nerves, lymphatics, and spermatic ducts enter and exit through the hilum

A

medistinum testes

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33
Q

patient prep

A

Warm room and warm gel - Prevents dartos and cremaster muscles from contracting

–
Simple instructions
Be relaxed and matter of fact/ nonchalant
Patient will stop listening once you instruct them to remove their clothing from the waist down
–
Give patient privacy
Leave the room
Turn the lights down a little

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34
Q

what’s the difference here?

A

rt dartos muscle iscontracted, lt not contracted

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35
Q

what do the testes look like on a sonogram?

A

(similar to thyroid)

medium level echoes
–
homogenous
–
often vessels seen within parenchyma
–
mediastinum is only echogenic area within testes
–
post vasectomy/infection/trauma can alter appearance
•
tubular ectasia
•
calcification

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36
Q

____ is the dilation of the rete testis. Common to see in males the are post vasectomy

A

tubular ectasia

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37
Q

sonographic appearance of the epididymis

A

–
Shape: epididymal head can be triangular, crescent, teardrop or round in shape.
–
Echogenicity: usually homogeneous and isoechoic to testicle. Appearance can change after vasectomy. Not uncommon to see cystic structures in the head (head is usually a bit brighter than the rest)
•
Cysts
•
Spermatoceles - little hole happens in epididymis and sperm gets out, the body walls it off and you get little cysts. can’t tell dif b/t this and epididymis cyst you are born with

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38
Q

scanning techniques

A

Open towel-Covering abdomen
–
Rolled towel-hold penis ventral side up. Pt. can hold this
–
Open towel in a sling- to keep scrotum up and out from between the legs
–
Pt. legs crossed
this will help testes to stay put
–Sheet to cover pt. legs
Some sonographers like to use a rolled up towel placed as a block between the legs to set the testes on. I have found this position inadequate to evaluate the testes thoroughly as the posterior approach is block by the towels.

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39
Q

imaging techniques and Td selection

A

Linear transducers
8 MHz or higher
Longer foot print is better

Appropriate depth setting

Gain settings
Unaffected side 1st, if appropriate
Do not readjust gain during scan if possible

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40
Q

indications for scrotal eval

A

Size changes or discrepancy
•Differentiating an intratesticular from an extratesticular palpable mass
•Finding occult neoplasm: known CA elsewhere, suspect testes as primary
•Etiology of acute scrotum: pain, swelling…
•? Varicoceles: dilated pampiniform plexus
•Undescended testes: aka cryptorchidism
•Trauma
•Fertility issues

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41
Q

protocol (long)

A

(same as renal) Long with measurement
–
Long lateral portion
–
Long medial portion
–
Long head of epididymis with measurement
–
Long body of epididymis with measurement
–
Long tail of the epididymis (typically include with the epididymal body image)

42
Q

protocol trans

A

Superior
–
Mid with measurement
–
Inferior
–
Bilateral Transverse
•
Dual screen if needed
–
Epididymal head with measurements

43
Q

what plane is this?

A

trans and below

44
Q

Which images shows the mediastinum? Find the epididymal tail Which images shows the superior part of the testis? Find the median raphe

A

what plane?

45
Q

what is this?

A

Spermatic cord
–
Along inguinal canal
–
Sometimes we need to look at the cord (right over pubic bone)
•
Inguinal hernias
•
Localized pain in this area

46
Q

what images do you want if the pt has a history of pain/infection?

mass or lump?

A

History of pain / infection
Testes and all parts of the epididymis must be evaluated
Doppler exam for flow to R/O torsion
–
Mass / Lump
Sonographer must find the mass and determine its origin
Hernias can cause enlarged scrotums

47
Q

what common findings are there in the epididymis?

A

spermatoceles and ipdidymal cysts

48
Q

the below are ____ of a testicular exam

Getting testicle symmetric
Scan through transversely and figure how testicle is laying
Inaccurate measurements
Not in the longest axis
Not symmetric
See the testicles but missing the scrotal pathology
Large spermatocele / epididymal cyst mistaken for hydrocele
Node vs. undescended testicle

(the below is a dirty sperrmatocele, a collection of sperm outside of the epididymis, could be a hemorrhagic hydrocele an abscess.)

A

pitfalls

49
Q

Two images have a small air bubble between the transducer and skin can you find them?

A

what do you see?

50
Q

this common variant is when One or both testes fail to descend to normal position.

A

cryptorchidism

51
Q

this scrotal variant is when there is more than one testicle per hemiscrotum…

A

polyorchidism

52
Q

indications for a scrotal exam

A

–
Pain
–
Enlargement
–
Palpable mass
–
Search for undescended testicle
–
Trauma
–
Male infertility

53
Q

_____ may be implatned in the case of erctile dysfunction.

A

erectile implants

54
Q

which chromosome determines gender?

A

Y

55
Q

the testis develop approx the same time and approx the same area as the ____.

A

kidneys

56
Q

The term undescended testis is used to describe what phenomena.

A

when one or both tesis fail to descend

57
Q

The descend of the testicles into the scrotum is trigger by

a. increased fetal intrabdominal pressure.
b. hormones.
c. the fetus turning into the cephalic position.
d. the scrotum becomes larger.

A

b

58
Q

The testes are retroperitoneal, when within the abdomen. Upon there descend through the canal a layer of ______ is pulled through the canal and into to scrotum along with the testes.

The specific term used to describe the pouching of the peritoneum through which the testes travel through is the _____ _____.

A

pertoneum

processus vaginalis

59
Q

A =
B =

Another term for scrotal septum is the ____ ____.

Name the AREA within the circle. Note it is not covered by a layer of peritoneum.

A

tunica vaginalis

tunica albuginea

median raphe

bare area

60
Q

The condition of an undescended testis is also known as Cryptorchidism. What do you believe the term Crypto means?

A

hidden or secret

61
Q

Image A is showing what? Image B is representative of normal.

A patient with this anatomic defect is a risk for what primary testicular problem?

A

an open processus vaginalis

torsion

62
Q

What does the term hemiscrotum mean?

Each hemiscrotum contains a testis, epididymis, portion of the spermatic cord and vas deferens. What is the vas deferens?

A

1/2 of the scrotum

the conduit duct for sperm betwee the tail of the ipididymis and the urethra

63
Q
  1. What divides the Rt. hemiscrotum from the Lt. hemiscrotum?
  2. The testes are both and endocrine and an exocrine gland. True / False
A

median raphe

true

64
Q
  1. Testosterone is produced from the exocrine portion of the testes. True / False
  2. Spematozoa are produced from the exocrine or endocrine portion of the gland?
A

false

exocrine

65
Q
  1. What are the functions of the epididymis?
  2. Name the parts of the epididymis.
    a.
    b.
    c.
A

storage of sperm and transport conduit

head (globu major), body and tail (globus minor)

66
Q
  1. The most proximal portion of the epididymis is the _____.
  2. The testes are divided into lobes by septula. Each lobe contains tubules from which spermatozoa are produced. Name these tubules.
A

head

seminiferous tubules

67
Q
  1. Within the seminiferous tubules are spermatogonium from which sperm cells are derived and two other types of cells. Name these cells.
  2. Testosterone is produce by which if these cells?
A

sertoli cells, leydig cells

leydig cells

68
Q
  1. A =
  2. What is the dotted circle is surrounding?
  3. What is the green circle is surrounding?
A

retes testis

globus major

body of the eipdidymis

69
Q
  1. What portion of the testis is the large arrow pointing to?
  2. What is the small arrow pointing to?
  3. What is the most distal portion of the epididymis?
A

inferior

vas deferens

globus minor

70
Q

Starting with the seminiferous tubules and ending with the urethra name the path of flow for sperm. Include the retes tesis.

A

seminiferous tubules, retes testis, eipdidymal head, body, tial, vas deferens, urethra (prostatic portion)

71
Q

Name the muscle which controls the position of the testes from the body.

  1. The spermatic cord contains all of the following EXCEPT.
    a. arteries / veins / lymphatic vessels
    b. vas deferens
    c. cremaster muscle
    d. head, body and tail of the epididymis
A

cmuscle

d

72
Q
  1. The area of the testicle in which arteries, veins, nerves, lymphatic vessels and spermatic ducts enter and leave the testis is called the _______ testis.
A

mediastinum testis

73
Q

Name the muscle within the scrotal wall which when contracted pulls the scrotal skin closer to the testes.

When this happens during an US, what does it do to the image?

A

dartos muscles

degrades the image, creates shadowing from the currugated folds of scrotal skin

74
Q

Dilation of the retes testis is not uncommon after this procedure.

What is the name of this condition when seen with US?

A

vasectomy

tubular ectasia (ectasia = dilation)

75
Q

What is the shape of the normal testicle?

What are the normal dimensions of the adult testicle?

Define spermatocele.

Name the plexus of veins found within the spermatic cord which drain the testicles of blood.

A

oval

length 3x5cm aP 2-4cm

a cystic structure containing sperm (viable or dead)

pampiniform plexus

76
Q

Name the TYPE of transducer which yields the BEST images of the testicles.

Which MHz. range would best be suited for a testicular examination.

a. 2-3 MHz.
b. 4-6 MHz.
c. 7-10 MHz.

A

linear

c

77
Q

When preparing a patient for a scrotal examination, through instructions with details will insure the patient is properly prepared for the exam. True / False

By using the sling method, where the scrotum is cradled on a towel draped over the patients thighs, the posterior aspect of the scrotum can be examined. True / False

Having a warm room and gel will help prevent the patients’ scrotum from contracting. True / False

A

F

T

T

78
Q

During a examination of the scrotum, both testes are routinely examined. When beginning an exam on an acute scrotum it is advisable to set the gain settings using which testicle?

A

the unaffected side

79
Q

Which of the following probes is the better choice when doing a scrotal examination? Why?

a. 8 MHz. linear 4cm footprint
b. 8 MHz. linear 6cm foot print

A

b - lgr footprint willimage greater portion of the testis

80
Q

The testes can be thoroughly examined from the anterior surface of the scrotum. True / False

Prior to beginning a scrotal examination, how can the penis be placed to be out of the way?

A

F

lay the penis uon th ept’s abd and lay a rolled towel across it

81
Q

List the 2-D testicular images taken during a routine scrotal examination. Assume that the entire testis can be seen in the longitudinal views. Don’t list the epididymal images. Hint: there will be an odd number of images.

A

long mid w/ measure

long medial

long lateral

trans sup, mid inf

tran bilateral

82
Q

All of the following are potential reasons for a scrotal US examination EXCEPT.

a. infertility
b. palpable mass
c. pain
d. difficulty urinating

One of the most common mistakes new sonographer make when measuring the testes is to foreshorten them. Why do you think this is?

A

d

failure to find the longest axis; settline fr the best guess

83
Q

What is the difference between the following?
Testes
Testis

A

testes - pleural

testis - singular

84
Q

What plane was this image taken in?
The asterisk is on which testicle?

A

trans

right

85
Q

what plane?

A

long

86
Q

This image was taken in the transverse plane. At what level was it taken? Why did you choose this answer?

a. superior
b. mid
c. inferior

A

b - mediastinum testis

87
Q

what is the arrow pointing to?

A

epididymal head

88
Q

wht is the arrow pointing to?

A

scrotal wall

89
Q

What is this image showing, why was it taken?

A

epididymal head, showing measurement

90
Q

what is the arrow pointing to?

A

mediastinum

91
Q

What is causing this image to appear this way.

A

dartos muscle contraction, skin of scrotum is corregated

92
Q

what is this condition?

A

tubular ectasia

93
Q

which image was taken in long?

A

a

94
Q

Why is this image part of the protocol, what is the image used for?

A

bilateral testes, shows echogenicity comparison

95
Q

what is the arrow pointing to?

A

median raphe

96
Q

What plane is this image taken in?

Name the anatomy the yellow arrow is pointing to?

Name the specific anatomy the green arrow is pointing to?

A

trans

mediastinum

epididymal body

97
Q

The following image shows contraction of the cremaster muscle. True / False

A

false - dartos muscle

98
Q

This image was taken from a patient with a history of oligospermia (low sperm count). What is displayed within the circle which could account for this history?

A

varicocele; dilated pampiniform plexus

99
Q

What specific anatomy is shown in this image?

What plane was this image taken in?

A

epiddiymal body

long

100
Q

what is the arrow pointing to?

A

epdidymal tail

101
Q

Name the structure from which the testicular arteries arise.

Name the structures into which each of the testicular veins drain into. Be specific.

A

aorta

rt to ivc, lt to renal vein

102
Q

Name this anatomic structure.

Which testis would you use to set your gain setting?
Rt. or Lt.

A

scrotal wall

lt

Abdomen (9 decks)

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