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Superficial Structures > Scrotum > Flashcards

Scrotum Flashcards

1
Q

role of sonography in evaluating the scrotum

A

Differentiate between intratesticular and extratesticular masses, Differentiate between cystic and solid masses, Evaluation of suspected testicular torsion, Evaluation of suspected testicular infection

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2
Q

shape of testis

A

Symmetric, oval shaped glands residing in the scrotum

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3
Q

size of testis

A

3 to 5 cm x 2 to 4 cm x 3 cm

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4
Q

Testis is divided into _____ conical lobules containing the seminiferous tubules

A

> 250 to 400

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5
Q

where is sperm created

A

seminiferous tubules

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6
Q

seminiferous tubules converge at apex of each lobule and anastomose (join) to form _______

A

rete testis in mediastinum.

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7
Q

Rete testis drains into ______ through efferent ductules

A

head of epididymis

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8
Q

sonographic appearance of testis

A

Smooth, medium gray structures with fine echo texture

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9
Q

Protrusion off the upper pole of the testis, located between the testis and the epididymis

A

appendix testis

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10
Q

size of epididymis

A

6 to 7 mm

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11
Q

Shape of epididymis

A

Tubular structure.

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12
Q

epididymis divided into

A

head, body, and tail

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13
Q

location of epididymis

A

Superior to upper pole of testis.

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14
Q

epididymis runs ________ to testis

A

superiorly posterolaterally

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15
Q

epididymis contains 10 to 15 efferent ductules from rete testis, which converge to form _________

A

single duct in body and tail, known as ductus epididymis.

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16
Q

ductus epididymis becomes _______

A

vas deferens and continues in spermatic cord

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17
Q

largest portion of epididymis

A

head

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18
Q

Smaller than the head of epididymis, Can be difficult to see sonographically. and Follows posterolateral aspect of testis from upper to lower pole

A

body of epididymis

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19
Q

Slightly larger than the body of epididymis and Positioned posterior to lower pole of testis

A

tail of epididymis

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20
Q

Small protuberance from head of epididymis

A

appendix epididymis

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21
Q

sonographic appearance of epididymis

A

Isoechoic or hypoechoic compared with testis, Echo texture coarser than testis

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22
Q

Dense, fibrous tissue that completely covers the testis

A

tunica albuginea

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23
Q

Posterior aspect of tunica albuginea reflects into testis to form vertical septum known as ________-

A

mediastinum testis

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24
Q

Multiple septa, or divisions, (known as the __________) are formed from tunica albuginea at mediastinum

A

septa testis

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25
Q

septa within testis separate it into _______

A

lobules

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26
Q

Mediastinum supports _______ coursing within testis

A

vessels and ducts

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27
Q

sonographic appearance of mediastinum testis

A

Bright, hyperechoic line coursing craniocaudad within testis

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28
Q

Lines the inner walls of scrotum, covering each testis and epididymis.

A

tunica vaginalis

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29
Q

tunica vaginalis consists of two layers: _______

A

parietal (inner lining of scrotal wall) and visceral (surrounds testis & epi)

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30
Q

bare area located where

A

posteriorly

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31
Q

________is the point where the testicle is against the scrotal wall, preventing torsion

A

bare area

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32
Q

________ travel through bare area

A

Blood vessels, lymphatics, nerves, spermatic ducts

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33
Q

where do hydroceles form

A

Between the layers of the tunica vaginalis.

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34
Q

A continuation of the ductus epididymis

A

vas deferens

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35
Q

vas deferens dilates where

A

at terminal portion near seminal vesicles, known as the ampulla

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36
Q

Vas deferens joins the duct of seminal vesicles to form _______, which empties into urethra

A

the ejaculatory duct

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37
Q

Urethra courses from ______ to ________

A

bladder to end of penis

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38
Q

In men, urethra transports _______ outside body.

A

both urine and semen

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39
Q

Extends from scrotum through inguinal canal and internal inguinal rings to pelvis.

A

spermatic cord

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40
Q

spermatic cord consist of

A

Vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, autonomic nerves, and fiber of cremaster

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41
Q

function of spermatic cord

A

suspends the testes in the scrotum

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42
Q

Primary source of blood flow to testis

A

right and left testicular arteries

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43
Q

testicular arteries arise from

A

abdominal aorta

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44
Q

testicular arteries descend in the retroperitoneum and enter the ______

A

spermatic cord

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45
Q

testicular arteries course along posterior surface of testis and pierce ________

A

tunica albuginea

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46
Q

testicular arteries form or give rise to ________

A

capsular arteries

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47
Q

centripetal arteries course

A

from testicular surface toward mediastinum along the septa

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48
Q

centrifugal arteries branch further into ________

A

arterioles and capillaries

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49
Q

capsular arteries give rise to

A

centripetal arteries

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50
Q

Before reaching the mediastinum, centripetal arteries curve backward forming _______

A

recurrent rami (centrifugal arteries)

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51
Q

capsular and centrifugal arteries show a _________ waveform

A

low resistance

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52
Q

__________ Accompany testicular artery within spermatic cord to supply extratesticular structures

A

cremasteric and deferential

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53
Q

__________ Have anastomoses with testicular artery and may provide some flow to testis

A

cremasteric and deferential

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54
Q

venous drainage of testis occurs through

A

veins of pampiniform plexus

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55
Q

Pampiniform plexus exits from _________ and courses in spermatic cord

A

mediastinum testis

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56
Q

prep for sonographic evaluation of scrotum

A

none

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57
Q

transducer to use for evaluation of scrotum

A

High-frequency (8 to 12 MHz) linear-array

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58
Q

Scrotum is often painful & swollen with ________

A

scrotal trauma

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59
Q

scrotal trauma is often the result of ______

A

MVA, Athletic injury, Direct trauma to scrotum, Straddle injury

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60
Q

goal of sonography in evaluating a patient with scrotal trauma

A

Determine if rupture is present.

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61
Q

_____ of testicular ruptures can be saved if surgery is within 72 hours

A

90%

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62
Q

________ of testicular ruptures can be saved after 72 hours

A

45%

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63
Q

complication of scrotal trauma include

A

Hydrocele and hematocele

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64
Q

sonographic appearance of scrotal trauma/rupture

A

Focal alteration of testicular parenchymal pattern, Interruption of tunica albuginea, Irregular testicular contour, Scrotal wall thickening, Hematocele

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65
Q

sonographic appearance of hematocele

A

Varies with age

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66
Q

sonographic appearance of acute hematocele

A

echogenic with numerous, highly visible echoes that can be seen to float or move in real time

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67
Q

sonographic evaluation of hematocele that ages over time

A

low-level echoes and develop fluid-fluid levels or septations

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68
Q

Heterogeneous areas within scrotum that may be large and cause displacement of the associated testis, may involve testis or epididymis or contained within scrotal wall

A

hematoma

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69
Q

color doppler can be useful to distinguish areas of hematoma, especially when involving testis, because color doppler will show _____

A

no flow

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70
Q

Infection of epididymis and testis.

A

epididymo-orchitis

71
Q

MOST COMMON CAUSE OF ACUTE SCROTAL PAIN IN ADULTS

A

epididymo-orchitis

72
Q

most common cause of epididymo-orchitis

A

spread of lower urinary tract infection via spermatic cord

73
Q

other causes of epididymo-orchitis

A

Mumps, Syphilis, TB, Viral, and Trauma

74
Q

clinical findings of epididymo-orhitis

A

Increasing scrotal pain x 1 to 2 days, Pain may be mild to severe, May have fever & urethral discharge

75
Q

sonographic findings of epididymo-orchitis

A

Enlarged, hypoechoic gland

If secondary hemorrhage has occurred, epididymis may contain focal hyperechoic areas.

Hyperemic flow confirmed with color Doppler

Scrotal wall thickening

Hydrocele (anechoic or contain low-level echoes)

Complex hydroceles (containing thick septations and low level echoes) may be associated with severe epididymitis and orchitis.

76
Q

If infection isolated to epididymis: testicle will appear _______

A

normal

77
Q

normal

A

enlarged testis, heterogeneous and slightly hypoechoic

78
Q

_____ is result of abnormal mobility of testis within scrotum

A

torsion

79
Q

MOST COMMON CAUSE OF ACUTE SCROTAL PAIN IN ADOLESCENTS

A

torsion

80
Q

most common cause of torsion

A

bell clapper deformity

81
Q

with ________, tunica vaginalis completely surrounds testis, epididymis, distal spermatic cord (instead of having the bare area where they are fixed to the scrotal wall), allowing them to move and rotate freely within scrotum.

A

bell clapper deformity

82
Q

salvageability rate of torsion within 5-6 hours

A

80% to 100%

83
Q

salvageability rate of torsion within 6-12 hours

A

70%

84
Q

salvageability rate of torsion after 12 hours hours

A

20%

85
Q

with torsion, _________ twist within scrotum, cutting off vascular supply within spermatic cord.

A

testis and epididymis

86
Q

Up to _______ of torsion patients have anatomic anomaly on both sides

A

60%

87
Q

Undescended testes are _______ than normal testes to be affected by torsion

A

10 times more likely

88
Q

with torsion, _______ flow affected first, causing swelling of scrotal structures on affected side

A

Venous

89
Q

If torsion continues, arterial flow obstructed and ________

A

testicular ischemia (inadequate blood supply) follows

90
Q

peak incidence age of torsion

A

14

91
Q

clinical symptoms of torsion

A

Sudden onset of scrotal pain with swelling on affected side

Severe pain causes nausea and vomiting in many patients

Frequently reported incidences of previous scrotal pain

92
Q

sonographic findings of torsion

A

Vary depending on how much time has passed

Early stages may appear normal

After 4 to 6 hours: swollen, hypoechoic testis

After 24 hours: heterogeneous testicle as result of hemorrhage, infarction, and necrosis

Scrotal skin thickening

Hydrocele

ABSENCE OF COLOR DOPPLER

Decreased color doppler flow may be seen when torsion is intermittent

93
Q

extratesticular cysts consist of

A

epididymal cysts, spermatoceles, and tunica albuginea cysts

94
Q

Most scrotal cysts are _______, found in tunica albuginea or epididymis.

A

extratesticular

95
Q

clinical findings of extratesticular cysts

A

Generally asymptomatic. May be palpable

96
Q

Cystic dilations of efferent ductules in epididymis:

A

spermatocele

97
Q

location of spermatocele

A

Always in epididymal head

98
Q

_______ may be seen more often following vasectomy

A

spermatocele

99
Q

spermatoceles contain

A

Proteinaceous fluid and spermatozoa

100
Q

location of epididymal cyst

A

Can be found ANYWHERE in the epididymis

101
Q

epididymal cysts contain

A

serous fluid

102
Q

Abnormal dilation of veins of pampiniform plexus (located within spermatic cord).

A

varicocele

103
Q

varicocele more common on the

A

left

104
Q

varicocele associated with

A

impaired fertility

105
Q

_________ Caused by incompetent venous valves within spermatic vein

A

primary varicocele

106
Q

_________ Caused by increased pressure on spermatic vein which may be result of renal hydronephrosis, abdominal mass, or liver cirrhosis. Abdominal malignancy invading left renal vein may cause varicocele with non-compressible veins

A

secondary varicoceles

107
Q

ANY non-compressible varicocele in a man older than 40 should prompt search for ________

A

retroperitoneal mass

108
Q

sonographic findings of varicocele

A

Tortuous tubes of varying sizes within spermatic cord near epididymal head.

Tubes may contain echoes that move with real-time imaging (blood flow)

Varicoceles measure > 2 mm in diameter.

Tend to increase in diameter in response to Valsalva maneuver

109
Q

a ________ is when Bowel, omentum, or other structures herniate into scrotum.

A

scrotal hernia

110
Q

sonographic findings of scrotal hernia

A

Peristalsis of the bowel, seen with real-time imaging, in the scrotal sac confirms the diagnosis of a scrotal hernia.

If peristalsis not seen, air-filled loops of bowel may be present showing a dirty acoustic shadow

111
Q

MOST COMMON CAUSE OF PAINLESS SCROTAL SWELLING

A

hydrocele

112
Q

hydroceles contain

A

serous fluid

113
Q

hydroceles may be idiopathic (cause unknown), but commonly associated with ________

A

epididymo-orchitis and torsion

114
Q

sonographic findings of hydrocele

A

Fluid filled collection located outside the anterolateral aspect of testis

Anechoic

May contain low-level echoes

115
Q

Collection of pus.

A

pyocele

116
Q

________ Occur with untreated infection or when an abscess ruptures into space between layers of tunica vaginalis

A

pyoceles

117
Q

pyoceles are indistinguishable from ______

A

hematoceles

118
Q

sonographic findings of pyoceles

A

Fluid collection containing internal echoes

Thickened septations

Loculations

119
Q

Collection of blood associated with trauma, surgery, neoplasms, or torsion.

A

hematocele

120
Q

sonographic findings of hematocele

A

Fluid collection containing internal echoes

Thickened septations

Loculations

121
Q

________ Occur as chronic inflammatory reaction to leakage of sperm.

A

spermatic granuloma

122
Q

________ Most frequently seen in patients with history of vasectomy

A

spermatic granuloma

123
Q

Most frequently seen in patients with history of vasectomy

A

spermatic granuloma

124
Q

Sperm granuloma may be located ________

A

anywhere within epididymis or vas deferens

125
Q

spermatic granulomas Can NOT be reliably differentiated from ________

A

epididymal tumors

126
Q

sonographic findings of spermatic granuloma

A

Well defined, solid mass

May be hypoechoic or isoechoic to epididymis

Often heterogeneous

Increased vascularity may be seen

127
Q

tubular ectasia benign or malignant

A

benign

128
Q

__________ is Associated with presence of a spermatocele, epididymal, or testicular cyst or other epididymal obstruction on same side as dilated tubules

A

tubular ectasia of the rete testis

129
Q

sonographic findings of tubular ectasia of the rete testis

A

Tiny tubular structures near mediastinum

Prominent hypoechoic channels near echogenic mediastinum

Avascular (no color Doppler seen)

130
Q

testicular cysts are more common in men _______

A

over 40 years old

131
Q

testicular cysts associated with

A

extratesticular spermatoceles

132
Q

testicular cysts located

A

near mediastinum

133
Q

sonographic findings of testicular cysts

A

characteristics of a cyst

134
Q

Tiny calcifications in the testis

A

microlithiasis

135
Q

characteristics of microlithiasis

A

Smaller < 3 mm.

Usually bilateral condition

Reported to have association with testicular malignancy; exact nature unknown

136
Q

testicular cancer prognosis

A

one of most curable forms of cancer

137
Q

testicular cancer more common in whom

A

caucasian men

138
Q

testicular cancer occurs most frequently between ages

A

20 and 34

139
Q

extratesticular masses are usually

A

benign

140
Q

intratesticular masses are usually

A

malignant

141
Q

clinical findings of testicular cancer

A

Painless lump

Testicular enlargement

Vague discomfort in scrotum

142
Q

classification of testicular mass is either

A

germ cell or non germ cell

143
Q

germ cell tumors are associated with elevated levels of

A

human chorionic gonadotropin and alphafetoprotein

144
Q

germ cell tumors account for ______ of all testicular tumors

A

95%

145
Q

germ cell tumors are highly

A

malignant

146
Q

most common germ cell tumor

A

seminoma

147
Q

types of germ cell tumors

A

Seminoma, Mixed embryonal cell, Teratocarcinoma, Yolk sac, Choriocarcinoma, Teratoma

148
Q

non germ cell tumors are generally

A

benign

149
Q

Most common testicular cancer

A

Seminoma

150
Q

sonographic findings of seminoma

A

Focal, hypoechoic masses, Homogeneous, Smooth border

151
Q

sonographic findings of embryonal cell tumors

A

More aggressive than seminoma, Heterogeneous, Less well-circumscribed, Areas of calcification, hemorrhage, fibrosis, Cystic components

152
Q

sonographic findings of teratoma

A

Heterogeneous, Well-defined borders, May show dense foci that produce acoustic shadowing

153
Q

sonographic findings of choriocarcinoma

A

Varies due to mixed cell types, Appearance is determined by predominant cell type present, Irregular borders

154
Q

how common are mets to the testicles

A

rare, usually occurring later in life

155
Q

Metastasis to testicle is ______, with multiple lesions found.

A

bilateral

156
Q

with mets, the primary tumor may originate from

A

Prostate or kidneys; less common sites include lung, pancreas, bladder, colon, thyroid, or melanoma

157
Q

sonographic findings of metastasis to the testicles

A

Solid hypoechoic mass, Hyperechoic, Mixture of both

158
Q

Most common bilateral secondary testicular neoplasm affecting men > 60 years

A

malignant lymphoma

159
Q

Involvement of testicle is 2nd most common secondary testicular neoplasm of __________. Most often found in children

A

leukemia

160
Q

cryptorchidism aka

A

undescended testicle

161
Q

During fetal growth, testes first appear in ________

A

retroperitoneum near kidneys

162
Q

Testes should descend into scrotum from inguinal canal ______

A

shortly before birth or early in neonatal period

163
Q

cryptorchidism more common in whom

A

premature babies

164
Q

location of undescended testis may be

A

in abdomen, inguinal canal or other ectopic location

165
Q

treatment for cryptorchidism

A

Orchiopexy: testis is pulled down into scrotum and fixed to scrotal wall

166
Q

sonographic findings of cryptorchidism

A

Undescended testis: smaller and less echogenic than normal testis

Usually oval with homogeneous texture

Mediastinum rarely seen

167
Q

with ________ Ectopic testicle cannot be manipulated into correct path of descent.

A

testicular ectopia

168
Q

Most common site for ectopic testicle to rest is ________.

A

superficial inguinal pouch

169
Q

anorchia more common on

A

left side

170
Q

definitive diagnosis of anorchia depends on

A

surgical diagnosis

171
Q

causes of anorchia

A

Intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero

172
Q

Testicular Duplication

A

Polyorchidism

173
Q

polyorchidism more common on

A

left side

174
Q

Increased incidence of ________ with polyorchidism

A

malignancy, cryptorchidism, inguinal hernia, torsion

Superficial Structures (3 decks)

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