Scrotum

Question 1

What does a normal testis look on US?

Answer 1

Homogeneous medium-level echo texture

Question 2

What surrounds the testicle?

Answer 2

Tunica albuginea (fibrous capsule)

Question 3

What makes up the mediastinum testis?

Answer 3

Multiple septations (septula) from the tunica albuginea

Question 4

What do the wedge-shaped compartments formed by septula contain?

Answer 4

Seminiferous tubules

Question 5

List the flow of sperm through the testis.

Answer 5

Seminiferous tubules > Tubuli recti > Rete testis > Efferent ductules > Ductus Epididymis > Vas deferens

Question 6

What is the rete testis?

Answer 6

Anastomosing network of delicate tubules located in the hilum of the testicle that carries sperm to the epididymis

Question 7

What do the efferent ductules do?

Answer 7

Carry seminal fluid from rete testis to the epididymis

Question 8

What are the different parts of the epididymis?

Answer 8

Head, body and tail

Question 9

How does the epididymis appear on US?

Answer 9

Isoechogenic, or slightly hyperechoic than the testis

Question 10

What is the appendix testis?

Answer 10

Remnant of the Mullerian duct; small ovoid structure located beneath the head of the epididymis

Question 11

What is the appendix epididymis?

Answer 11

Detached efferent duct, small stalk projecting off the epididymis; derived from the Wolffian duct

Question 12

What is the dartos?

Answer 12

Layer of muscle fibers lying beneath the scrotal skin dividing the scrotum into 2 chambers

Question 13

What are the scrotal raphe?

Answer 13

The 2 scrotal chambers

Question 14

What is the tunica vaginalis?

Answer 14

Saccular extension of the peritoneum into the scrotal chambers

Question 15

Which layer of the tunica vaginalis covers the testis and epididymis?

Answer 15

Inner or visceral layer

Question 16

What layer of the tunica vaginalis lines the scrotal chamber?

Answer 16

Outer or parietal layer

Question 17

What supplies the testicular blood flow?

Answer 17

Deferential artery
Cremasteric (external spermatic) artery
Testicular artery

Question 18

What does the testicular artery branch into?

Answer 18

Capsular and centripetal arteries

Question 19

What does the spermatic cord consist of?

Answer 19

Vas deferens
Cremasteric, deferential, testicular arteries
Pampiniform plexus of veins
Lymphatics
Nerves

Question 20

Which testicular lesions are malignant?

Answer 20

Intratesticular

Question 21

How do malignant testicular neoplasms appear on US?

Answer 21

Hypoechoic compared to normal testicular parenchyma

Question 22

What is the most common germ cell tumor?

Answer 22

Seminoma

Question 23

What are risk factors for seminomas?

Answer 23

Cryptotorchidism
FamHx
Infertility
Klinefelter syndrome
Down syndrome
Smoking
Caucasian

Question 24

What tumor markers should be evaluated for germ cell tumors?

Answer 24

Beta-hCG
AFP
LDH

Question 25

Where should one look for lymph nodes when a seminoma is discovered?

Answer 25

Paraaortic

Question 26

What other cell types do nonseminomas contain?

Answer 26

Embryonal carcinomas Teratomas Yolk sac tumors Choriocarcinomas

Question 27

Where does lymphatic mets occur in nonseminomas?

Answer 27

Retroperitoneal nodes

Question 28

What is the most common testicular tumor in infants and young boys?

Answer 28

Yolk sac tumors

Question 29

What is a Leydig cell tumor?

Answer 29

Rare stromal testicular tumor in boys (5-10yo) and men (30-60yo)

Question 30

What do Leydig cell tumors produce?

Answer 30

Testosterone resulting in precocious puberty

Question 31

Which lab marker is indicative of nonseminomatous tumor?

Answer 31

Alpha-fetoprotein

Question 32

What are the 2 types of benign testicular cysts?

Answer 32

Cysts of tunica albuginea | Intratesticular cysts

Question 33

What is an epidermoid cyst?

Answer 33

Benign tumor of germ cell origin | Well-circumscribed solid tumors lying beneath tunica albuginea

Question 34

How do epidermoid cysts appear on US?

Answer 34

Well-defined, solid hypoechoic mass with an echogenic capsule or onion ring pattern

Question 35

How do testicular abscesses appear on US?

Answer 35

Enlarged testicle carrying predominantly fluid-filled mass with hypoechoic or mixed echogenic areas

Question 36

How does a testicular infarct appear on US?

Answer 36

Depends on age of infarct Initial- focal or diffuse hypoechoic testicle Then testicle decreases in size with increased echogenicity

Question 37

What is a hydrocele?

Answer 37

Serous fluid that accumulates within the tunica vaginalis or between its layers

Question 38

What is a hematocele?

Answer 38

When blood fills the scrotal chamber associated with trauma

Question 39

What is a varicocele?

Answer 39

Dilatation of the pampiniform venous plexus of the testicular veins which drain the testicle

Question 40

Where are 90% of varicoceles located?

Answer 40

The left side because of the length of the left testicular vein as it drains into the left renal vein

Question 41

What are causes of unilateral scrotal pain?

Answer 41

Testicular torsion Epididymitis Varicocele thrombosis

Question 42

What is the most common correctable cause of male infertility?

Answer 42

Varicocele

Question 43

What is a scrotal hernia?

Answer 43

Bowel protruding through the inguinal canal into the tunica vaginalis

Question 44

What structure do extratesticular tumors involve?

Answer 44

Epididymis

Question 45

What is the most common extratesticular tumor?

Answer 45

Adenomatoid tumor

Question 46

What are spermatoceles?

Answer 46

Cystic masses of the epididymis that result from dilatatian of the epididymal tubules

Question 47

What are more common - spermatoceles or epididymal cysts?

Answer 47

Spermatoceles

Question 48

How do spermatoceles appear on US?

Answer 48

Anechoic, well-defined masses with no or few internal echoes | Usually occur at the epididymal head

Question 49

What is the differential diagnosis of the acutely painful scrotum?

Answer 49

``` Testicular torsion Trauma Epididymitis/orchitis Incarcerated hernia Torsion of the appendix testis Varicocele thrombosis ```

Question 50

What is the most common condition that causes acute scrotal pain?

Answer 50

Acute epididymitis

Question 51

What usually causes acute epididymitis in men under 35 years of age?

Answer 51

Chlamydia and gonorrhea

Question 52

What usually causes acute epididymitis in prepubertal boys and men older than 35 years of age?

Answer 52

Urinary tract infections

Question 53

How does epididymitis appear on ultrasound?

Answer 53

Enlarged hypoechoic epididymis Increased blood flow (hyperemia) Reactive hydrocele Scrotal wall thickening

Question 54

What are sonographic findings of orchitis?

Answer 54

Enlarged hypoechoic testicle Increased blood flow (hyperemia) Decreased arterial resistance

Question 55

What congenital anomaly causes the testicle to twist causing testicular torsion?

Answer 55

Lack of attachment from the testicle to the tunica vaginalis

Question 56

At what time period does the testicle become enlarged and hypoechoic in testicular ischemia?

Answer 56

Six hours

Question 57

What will better optimize slow blood flow to rule out a complete torsion?

Answer 57

Decreasing pulse repetition frequency (color scale)

Question 58

What is cryptorchidism?

Answer 58

Hidden testicle and generally refers to an undescended testicle

Question 59

What are complications of cryptorchidism?

Answer 59

Infertility | Malignancy

Question 60

What is the most common location of the cryptorchid testis?

Answer 60

Inguinal canal or pre-scrotal positions

Question 61

How rare is anorchia or congenital absence of testicle?

Answer 61

4% of patients with cryptorchidism