Scrotum from Expert DDx

Question 0

Please give example of common and rare but important causes of decreased testicular size..

Answer 0

Common cause
- Testicular infarction
> Focal mixed echo = focal infarction
> Uniform hypoecho = diffuse infarction
- Scrotal trauma
- Chronic mass effect
 > from tumor or hydrocele
- Undescended testes

Rare but important
- Hypogonadism
> diffuse heterogeneous echopattern
- Polyorchidism

Question 1

When to considered testicular atrophy ?

When considered significant ?

Answer 1

1. If combined axis measurments of testes ต่างกัน >/= 10 mm
2. ขนาดอัณฑะ < 4 x 2 cm

Considered significant < 50% volume of unaffected testes

Question 2

Testicular infarction may developed from ?

Answer 2

i) Ischemic orchitis (Cx of hernia Sx)
> Linear or band of hypodensity

ii) Severe epididymo-orchitis, lead infarcted
> Appearing, focal or patchy,
ill-defined infarct

iii) Missed torsion

Question 3

Scrotal trauma lead to testicular atrophy by ?

Answer 3

• Hematoma increase pressure
• Compromise blood supply
• Developed infarction
• Resorption of nonviable tissue.

Same as chronic mass effect mechanism..

Question 4

Concerning about Hypogonadism.
Please give image appearance findings.
Please give example of etiologies .

Answer 4

Image appearance
> diffuse heterogeneous echopattern

Example causes..

1. Kallman syndrome
2. Pituitary neoplasm

Question 5

Please described appearance of polyorchidism..

Answer 5

Supernumerary testes (Duplicated testes)
> Tunica albugenia surrounds and separate testis.
> Epididymis may also duplicated.

Question 6

Please give DDx of paratesticular (extratesticular) cyst..

Common and less common

Answer 6

Common:
> Hydrocele
> Varicocele
> Spermatocele
> Epididymal cyst

Less Common
> Tunica albuginea cyst
> Acute hematocele
> Pyocele

Question 7

What do hydrocele fluid collection in ?
A) Tunica albugenia
B) Tunica vaginalis
C) Both
D) None of above

Answer 7

Tunica vaginalis

Question 8

Owing to nature of hydrocele it will enveloped the testes .

Does the above sentence is true ?

Answer 8

Yes, this is the distinctive feature of hydrocele and other cyst **

Quite important

Question 9

What is the serpentiginous dilated vein in varicocele ?

Answer 9

Pampiniform plexus (Peritesticular vein), the result of incompetent valve of spermatic vein

Question 10

What is the normal upper limit of peritesticular veins ?

Answer 10

2 mm in diameter

Question 11

Between left and right and bilateral varicocele,

1. which is/are suggested for further investigation ?
2. Left and right gonadal veins drain into ?
3. which one is most common and why ?

Answer 11

1. Isolated right varicocele
2. Left gonadal vein drain to left renal vein
   Right gonadal vein drain to IVC
3. Left (85%), bilateral (15%), because course of left gonadal vein recieve pressure from SMA, the pressure on left is higher than right side

Question 12

The diagnosis of varicocele should be made when ?

1. _______________
2. _______________

Answer 12

1. Persistent of Valsava-augmented flow >1 seconds

2. Veins are dilated on gray-scale sonography.

Question 13

About spermatocele..

• What is the common location ?
• What is it US appearance ?
• What is it content ?
• What are it association with other condition ?

Answer 13

• Usually developed at head of epididymis
• Can anechoic or has internal echo
• Containing spermatozoa
• Associated with Tunica albuginea cyst, intratesticular cyst, dilated rete testis

Question 14

About epididymal cyst ..

• What is the common location ?
• What is it content ?
• What is it US appearance ?

Answer 14

• May located at head, body or tail of epididymis
• Serous fluid, no spermatozoa
• Anechoic, simple cyst

Question 15

About tunica albuginea Cyst..

- What is it US appearance?

Answer 15

Simple cyst, common small size located periphery