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Abdominal Sonography > Scrotum > Flashcards

Scrotum Flashcards

1
Q

What does a normal testis look on US?

A

Homogeneous medium-level echo texture

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2
Q

What surrounds the testicle?

A

Tunica albuginea (fibrous capsule)

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3
Q

What makes up the mediastinum testis?

A

Multiple septations (septula) from the tunica albuginea

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4
Q

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

A

Seminiferous tubules

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5
Q

List the flow of sperm through the testis.

A

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

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6
Q

What is the rete testis?

A

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

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7
Q

What do the efferent ductules do?

A

Carry seminal fluid from rete testis to the epididymis

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8
Q

What are the different parts of the epididymis?

A

Head, body and tail

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9
Q

How does the epididymis appear on US?

A

Isoechogenic, or slightly hyperechoic than the testis

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10
Q

What is the appendix testis?

A

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

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11
Q

What is the appendix epididymis?

A

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

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12
Q

What is the dartos?

A

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

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13
Q

What are the scrotal raphe?

A

The 2 scrotal chambers

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14
Q

What is the tunica vaginalis?

A

Saccular extension of the peritoneum into the scrotal chambers

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15
Q

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

A

Inner or visceral layer

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16
Q

What layer of the tunica vaginalis lines the scrotal chamber?

A

Outer or parietal layer

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17
Q

What supplies the testicular blood flow?

A

Deferential artery
Cremasteric (external spermatic) artery
Testicular artery

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18
Q

What does the testicular artery branch into?

A

Capsular and centripetal arteries

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19
Q

What does the spermatic cord consist of?

A 
Vas deferens
Cremasteric, deferential, testicular arteries
Pampiniform plexus of veins
Lymphatics
Nerves
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20
Q

Which testicular lesions are malignant?

A

Intratesticular

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21
Q

How do malignant testicular neoplasms appear on US?

A

Hypoechoic compared to normal testicular parenchyma

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22
Q

What is the most common germ cell tumor?

A

Seminoma

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23
Q

What are risk factors for seminomas?

A 
Cryptotorchidism
FamHx
Infertility
Klinefelter syndrome
Down syndrome
Smoking
Caucasian
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24
Q

What tumor markers should be evaluated for germ cell tumors?

A

Beta-hCG
AFP
LDH

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25
Q

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

A

Paraaortic

26
Q

What other cell types do nonseminomas contain?

A

Embryonal carcinomas
Teratomas
Yolk sac tumors
Choriocarcinomas

27
Q

Where does lymphatic mets occur in nonseminomas?

A

Retroperitoneal nodes

28
Q

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

A

Yolk sac tumors

29
Q

What is a Leydig cell tumor?

A

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

30
Q

What do Leydig cell tumors produce?

A

Testosterone resulting in precocious puberty

31
Q

Which lab marker is indicative of nonseminomatous tumor?

A

Alpha-fetoprotein

32
Q

What are the 2 types of benign testicular cysts?

A

Cysts of tunica albuginea

Intratesticular cysts

33
Q

What is an epidermoid cyst?

A

Benign tumor of germ cell origin

Well-circumscribed solid tumors lying beneath tunica albuginea

34
Q

How do epidermoid cysts appear on US?

A

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

35
Q

How do testicular abscesses appear on US?

A

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

36
Q

How does a testicular infarct appear on US?

A

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

37
Q

What is a hydrocele?

A

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

38
Q

What is a hematocele?

A

When blood fills the scrotal chamber associated with trauma

39
Q

What is a varicocele?

A

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

40
Q

Where are 90% of varicoceles located?

A

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

41
Q

What are causes of unilateral scrotal pain?

A

Testicular torsion
Epididymitis
Varicocele thrombosis

42
Q

What is the most common correctable cause of male infertility?

A

Varicocele

43
Q

What is a scrotal hernia?

A

Bowel protruding through the inguinal canal into the tunica vaginalis

44
Q

What structure do extratesticular tumors involve?

A

Epididymis

45
Q

What is the most common extratesticular tumor?

A

Adenomatoid tumor

46
Q

What are spermatoceles?

A

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

47
Q

What are more common - spermatoceles or epididymal cysts?

A

Spermatoceles

48
Q

How do spermatoceles appear on US?

A

Anechoic, well-defined masses with no or few internal echoes

Usually occur at the epididymal head

49
Q

What is the differential diagnosis of the acutely painful scrotum?

A 
Testicular torsion
Trauma
Epididymitis/orchitis
Incarcerated hernia
Torsion of the appendix testis
Varicocele thrombosis
50
Q

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

A

Acute epididymitis

51
Q

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

A

Chlamydia and gonorrhea

52
Q

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

A

Urinary tract infections

53
Q

How does epididymitis appear on ultrasound?

A

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

54
Q

What are sonographic findings of orchitis?

A

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

55
Q

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

A

Lack of attachment from the testicle to the tunica vaginalis

56
Q

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

A

Six hours

57
Q

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

A

Decreasing pulse repetition frequency (color scale)

58
Q

What is cryptorchidism?

A

Hidden testicle and generally refers to an undescended testicle

59
Q

What are complications of cryptorchidism?

A

Infertility

Malignancy

60
Q

What is the most common location of the cryptorchid testis?

A

Inguinal canal or pre-scrotal positions

61
Q

How rare is anorchia or congenital absence of testicle?

A

4% of patients with cryptorchidism

Abdominal Sonography (12 decks)

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