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SONOCAN ABD Review > Scrotum Notes > Flashcards

Scrotum Notes Flashcards

1
Q

What is the scrotum?

A

A pouch of loose skin and fascia, continuous with the abdomen.

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2
Q

What structures are contained within the scrotum? 4

A
  1. Testicles
  2. Epididymis
  3. Vas deferens
  4. Spermatic cord.
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3
Q

What is the thickness of the scrotal wall?

A

2-8 mm.

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4
Q

What is the tunica vaginalis?

A

It lines the scrotum and consists of parietal and visceral layers.

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5
Q

What is considered normal fluid volume between the layers of the tunica vaginalis?

A

1-2 ml of fluid.

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6
Q

What are the dimensions of adult testicles?

A

Length: 3 to 5 cm, Width: 2 to 4 cm, AP: 3 cm.

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7
Q

What is the tunica albuginea?

A

A fibrous layer surrounding each testicle.

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8
Q

What is the function of seminiferous tubules?

A

Site of spermatogenesis.

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9
Q

What is the function of the epididymis?

A

Conveys sperm to the seminal vesicles; storage and maturation of sperm.

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10
Q

What is the size of the epididymis?

A

6-7 cm in length.

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11
Q

What does the spermatic cord connect?

A

Connects the testes to the pelvis and abdomen.

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12
Q

What arteries supply the testicles?

A

Testicular arteries from the aorta.

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13
Q

What is the scanning technique for scrotal ultrasound?

A

No prep required; patient lies supine with legs slightly apart.

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14
Q

What are the indications for a scrotal ultrasound? 8

A
  1. Palpable masses
  2. Pain
  3. Enlarged scrotum
  4. Cystic vs. solid
  5. Torsion
  6. Undescended testes
  7. Trauma
  8. Post orchiectomy.
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15
Q

What is the sonographic appearance of normal testicles?

A

Homogeneous medium level echoes similar to the thyroid.

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16
Q

What is hydrocele?

A

Collection of fluid between the tunica vaginalis layers (> 2mm of separation).

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17
Q

What is the most common cause of painless scrotal swelling?

A

Hydrocele.

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18
Q

What is varicocele?

A

Abnormally dilated veins of the pampiniform plexus (>2mm in diameter).

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19
Q

What is the typical clinical presentation of hematocele?

A

Blood in the scrotal sac due to trauma, surgery, neoplasms, or torsion.

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20
Q

What are the complications of cryptorchidism?

A

Infertility and increased risk of testicular cancer (48X the risk).

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21
Q

What is the treatment for undescended testicles?

A

Orchiopexy for infants and young children; orchiectomy for older children and adults.

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22
Q

What is the sonographic appearance of a simple hydrocele?

A

Anechoic with increased through transmission.

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23
Q

What is a sonographic indicator of secondary varicoceles?

A

Extratesticular collection or numerous anechoic structures >2mm in diameter.

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24
Q

Where are secondary varicoceles typically located?

A

Proximal to the superior pole of the testicle and epididymal head.

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25
Q

What maneuver can demonstrate changes in secondary varicoceles?

A

Valsalva maneuver.

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26
Q

What imaging technique is used for secondary varicoceles?

A

Color flow imaging.

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27
Q

What are scrotal hernias?

A

Scrotal hernias are inguinal hernias that descend into the scrotum, usually containing omentum or bowel.

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28
Q

What may be associated with scrotal hernias?

A

Scrotal hernias may be associated with heavy lifting.

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29
Q

What contents may be found in a hernia?

A

A hernia may contain mesentery, fat, or bowel.

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30
Q

How are most hernias diagnosed?

A

Most hernias are diagnosed clinically.

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31
Q

What are the signs and symptoms of a hernia?

A

Signs and symptoms include scrotal enlargement, pain, and blood in stool.

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32
Q

What are the sonographic features of a hernia? 3

A

Sonographic features include a
1. Mass outside the testicle
2. Echogenic/anechoic mass
3. Peristalsis noted if the hernia is not incarcerated.

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33
Q

What types of injuries can cause trauma to the testicle?

A

Trauma can result from direct injury or straddle injury.

34
Q

What complications can arise from testicular trauma?

A

Complications include hematoma, hematocele, or ruptured testicle.

35
Q

What is a ruptured testicle?

A

A ruptured testicle is a surgical emergency that may require repair of the tunica or removal of the testicle.

36
Q

What is the most common cause of a ruptured testicle?

A

Blunt trauma is the most common cause of a ruptured testicle.

37
Q

What is the salvageability of a ruptured testicle if surgery is performed within 72 hours?

A

90% of the testicle is salvageable if surgery is performed within 72 hours after injury.

38
Q

What happens if a ruptured testicle is not repaired?

A

If not repaired, it can lead to loss of function and atrophy.

39
Q

What are the sonographic features of a ruptured testicle? 3

A

Sonographic features include
1. Focal areas of altered echogenicity
2. Irregular capsule/contour
3. Hematocele.

40
Q

What is torsion of the spermatic cord?

A

Torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle.

41
Q

Who is most commonly affected by testicular torsion?

A

Testicular torsion is common in young males less than 25 years of age.

42
Q

What is the prognosis if surgery is performed within 6 hours of torsion?

A

80 to 100% of testicles can be salvaged if surgery is performed within 6 hours after torsion.

43
Q

What happens to the testicle after 12 hours of torsion?

A

Complete infarction of the testicle occurs after 12 hours.

44
Q

What are the stages of testicular torsion? 3

A

The stages of torsion are
1. acute (within 24 hours)
2. Subacute (24 hours to 10 days)
3. Chronic (after 10 days).

45
Q

What are the two types of testicular torsion?

A

The two types of torsion are intravaginal and extravaginal.

46
Q

What characterizes intravaginal torsion? 2

A
  1. Intravaginal torsion is the most common type
  2. Generally occurring during puberty due to anomalous suspension of the testicle.
47
Q

What characterizes extravaginal torsion?

A

Extravaginal torsion is seen in newborns due to poor or absent attachment of the testis to the scrotal wall.

48
Q

What are the sonographic features of testicular torsion? 4

A

Sonographic features vary in the acute stage
1. Showing enlarged testicle and epididymis
2. Hypoechoic testicle
3. Scrotal skin thickening
4. Absent arterial flow if complete torsion.

49
Q

What are the signs and symptoms of testicular torsion? 2

A

Signs and symptoms include
1. Sudden onset of extreme scrotal pain
2. Nausea, and vomiting.

50
Q

What is epididymitis?

A

Epididymitis is inflammation/infection of the epididymis and the most common cause of acute scrotal pain and tenderness.

51
Q

What are the signs and symptoms of epididymitis? 4

A

Signs and symptoms include
1. Fever
2. Pain increasing over 1 to 2 days
3. Dysuria
4. Discharge.

52
Q

What are the sonographic features of epididymitis? 4

A

Sonographic features include
1. Thick enlarged epididymis
2. Hypoechoic/heterogeneous appearance
3. Scrotal thickening
4. Increased blood flow.

53
Q

What is orchitis? What is it secondary to?

A

Orchitis is inflammation of the testis, typically secondary to epididymitis.

54
Q

What is a common cause of orchitis in men under 35?

A

The most common cause of orchitis in men under 35 is chlamydia.

55
Q

What are the sonographic features of orchitis? 2

A

Sonographic features include
1. Hypoechoic areas adjacent to enlarged epididymis
2. Decreased echogenicity of the entire testicle.

56
Q

What is an abscess in relation to epididymo-orchitis?

A

An abscess is a common complication of untreated epididymo-orchitis and is considered a surgical emergency.

57
Q

What are the signs and symptoms of an abscess? 3

A

Signs and symptoms include
1. Pain
2. Fever
3. Swollen scrotum.

58
Q

What are scrotal pearls?

A

Scrotal pearls are calcifications floating on the tunica or within the scrotal sac.

59
Q

What is a spermatocele?

A

A spermatocele is a retention cyst filled with nonviable sperm, typically located at the epididymal head.

60
Q

What are the sonographic features of a spermatocele? 3

A

Sonographic features include a
1. Well-defined
2. Anechoic mass
3. Acoustic enhancement.

61
Q

What are true cysts in the scrotum?

A

True cysts are filled with serous fluid and are typically asymptomatic.

62
Q

What are non-germ cell neoplasms?

A

Non-germ cell neoplasms are mostly benign tumors that represent less than 5% of testicular tumors.

63
Q

What is an adenomatoid tumor? How common is it? Where is it typically found?

A
  1. An adenomatoid tumor is a benign tumor
  2. The most common extratesticular tumor
  3. Typically found in the epididymis.
64
Q

What is microlithiasis?

A

Microlithiasis refers to calcifications in the seminiferous tubules, with isolated microlithiasis being common.

65
Q

What is the significance of more than 5 calcifications in microlithiasis?

A

More than 5 calcifications per transducer field has a strong association with the development of malignant neoplasms.

66
Q

What are the characteristics of malignant pathologies in the scrotum?

A

Malignant pathologies typically present as painless scrotal enlargement or hardness of the testicle.

67
Q

What is the most common germ cell tumor?

A

The most common germ cell tumor is seminoma.

68
Q

What is the prognosis for seminomas?

A

Seminomas are the least aggressive germ cell tumors and have the best prognosis.

69
Q

What are non-seminomatous germ cell tumors?

A

Non-seminomatous germ cell tumors are more aggressive and can develop visceral metastases.

70
Q

What is embryonal cell carcinoma?

A

Embryonal cell carcinoma is the second most common germ cell tumor and is the most aggressive tumor.

71
Q

What is choriocarcinoma?

A

Choriocarcinoma is an uncommon, highly malignant tumor with a poor prognosis.

72
Q

What characterizes teratomas?

A

Teratomas can be benign in children and malignant in adults, with cystic and solid components.

73
Q

What is a ‘burned-out’ tumor?

A

A ‘burned-out’ tumor is a tumor that has regressed but may still have residual effects.

74
Q

What are the common metastatic tumors of the testes?

A

The most common metastatic tumor of the testes is lymphoma.

75
Q

What are the common changes seen post-vasectomy?

A

Post-vasectomy changes may include epididymal enlargement, heterogeneous appearance, and sperm granulomas.

76
Q

What are idymis and rete testis?

A

Variable sized cystic lesions seen in the region of the mediastinum and epididymis.

May be mistaken for a neoplasm.

77
Q

What is a characteristic of idymis and rete testis regarding color flow?

A

They show no color flow.

78
Q

Are idymis and rete testis typically unilateral or bilateral?

A

They are frequently bilateral and asymmetrical.

79
Q

What is often associated with idymis and rete testis?

A

They are often associated with a spermatocele.

80
Q

What should be assessed in the scrotal space post orchiectomy? 3

A

Assessment of scrotal space for
1. Hematomas
2. Abscesses
3. Recurrent neoplasms
4. Prosthesis.

SONOCAN ABD Review (32 decks)

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