Scrotum Notes Flashcards
What is the scrotum?
A pouch of loose skin and fascia, continuous with the abdomen.
What structures are contained within the scrotum? 4
- Testicles
- Epididymis
- Vas deferens
- Spermatic cord.
What is the thickness of the scrotal wall?
2-8 mm.
What is the tunica vaginalis?
It lines the scrotum and consists of parietal and visceral layers.
What is considered normal fluid volume between the layers of the tunica vaginalis?
1-2 ml of fluid.
What are the dimensions of adult testicles?
Length: 3 to 5 cm, Width: 2 to 4 cm, AP: 3 cm.
What is the tunica albuginea?
A fibrous layer surrounding each testicle.
What is the function of seminiferous tubules?
Site of spermatogenesis.
What is the function of the epididymis?
Conveys sperm to the seminal vesicles; storage and maturation of sperm.
What is the size of the epididymis?
6-7 cm in length.
What does the spermatic cord connect?
Connects the testes to the pelvis and abdomen.
What arteries supply the testicles?
Testicular arteries from the aorta.
What is the scanning technique for scrotal ultrasound?
No prep required; patient lies supine with legs slightly apart.
What are the indications for a scrotal ultrasound? 8
- Palpable masses
- Pain
- Enlarged scrotum
- Cystic vs. solid
- Torsion
- Undescended testes
- Trauma
- Post orchiectomy.
What is the sonographic appearance of normal testicles?
Homogeneous medium level echoes similar to the thyroid.
What is hydrocele?
Collection of fluid between the tunica vaginalis layers (> 2mm of separation).
What is the most common cause of painless scrotal swelling?
Hydrocele.
What is varicocele?
Abnormally dilated veins of the pampiniform plexus (>2mm in diameter).
What is the typical clinical presentation of hematocele?
Blood in the scrotal sac due to trauma, surgery, neoplasms, or torsion.
What are the complications of cryptorchidism?
Infertility and increased risk of testicular cancer (48X the risk).
What is the treatment for undescended testicles?
Orchiopexy for infants and young children; orchiectomy for older children and adults.
What is the sonographic appearance of a simple hydrocele?
Anechoic with increased through transmission.
What is a sonographic indicator of secondary varicoceles?
Extratesticular collection or numerous anechoic structures >2mm in diameter.
Where are secondary varicoceles typically located?
Proximal to the superior pole of the testicle and epididymal head.
What maneuver can demonstrate changes in secondary varicoceles?
Valsalva maneuver.
What imaging technique is used for secondary varicoceles?
Color flow imaging.
What are scrotal hernias?
Scrotal hernias are inguinal hernias that descend into the scrotum, usually containing omentum or bowel.
What may be associated with scrotal hernias?
Scrotal hernias may be associated with heavy lifting.
What contents may be found in a hernia?
A hernia may contain mesentery, fat, or bowel.
How are most hernias diagnosed?
Most hernias are diagnosed clinically.
What are the signs and symptoms of a hernia?
Signs and symptoms include scrotal enlargement, pain, and blood in stool.
What are the sonographic features of a hernia? 3
Sonographic features include a
1. Mass outside the testicle
2. Echogenic/anechoic mass
3. Peristalsis noted if the hernia is not incarcerated.
What types of injuries can cause trauma to the testicle?
Trauma can result from direct injury or straddle injury.
What complications can arise from testicular trauma?
Complications include hematoma, hematocele, or ruptured testicle.
What is a ruptured testicle?
A ruptured testicle is a surgical emergency that may require repair of the tunica or removal of the testicle.
What is the most common cause of a ruptured testicle?
Blunt trauma is the most common cause of a ruptured testicle.
What is the salvageability of a ruptured testicle if surgery is performed within 72 hours?
90% of the testicle is salvageable if surgery is performed within 72 hours after injury.
What happens if a ruptured testicle is not repaired?
If not repaired, it can lead to loss of function and atrophy.
What are the sonographic features of a ruptured testicle? 3
Sonographic features include
1. Focal areas of altered echogenicity
2. Irregular capsule/contour
3. Hematocele.
What is torsion of the spermatic cord?
Torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle.
Who is most commonly affected by testicular torsion?
Testicular torsion is common in young males less than 25 years of age.
What is the prognosis if surgery is performed within 6 hours of torsion?
80 to 100% of testicles can be salvaged if surgery is performed within 6 hours after torsion.
What happens to the testicle after 12 hours of torsion?
Complete infarction of the testicle occurs after 12 hours.
What are the stages of testicular torsion? 3
The stages of torsion are
1. acute (within 24 hours)
2. Subacute (24 hours to 10 days)
3. Chronic (after 10 days).
What are the two types of testicular torsion?
The two types of torsion are intravaginal and extravaginal.
What characterizes intravaginal torsion? 2
- Intravaginal torsion is the most common type
- Generally occurring during puberty due to anomalous suspension of the testicle.
What characterizes extravaginal torsion?
Extravaginal torsion is seen in newborns due to poor or absent attachment of the testis to the scrotal wall.
What are the sonographic features of testicular torsion? 4
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.
What are the signs and symptoms of testicular torsion? 2
Signs and symptoms include
1. Sudden onset of extreme scrotal pain
2. Nausea, and vomiting.
What is epididymitis?
Epididymitis is inflammation/infection of the epididymis and the most common cause of acute scrotal pain and tenderness.
What are the signs and symptoms of epididymitis? 4
Signs and symptoms include
1. Fever
2. Pain increasing over 1 to 2 days
3. Dysuria
4. Discharge.
What are the sonographic features of epididymitis? 4
Sonographic features include
1. Thick enlarged epididymis
2. Hypoechoic/heterogeneous appearance
3. Scrotal thickening
4. Increased blood flow.
What is orchitis? What is it secondary to?
Orchitis is inflammation of the testis, typically secondary to epididymitis.
What is a common cause of orchitis in men under 35?
The most common cause of orchitis in men under 35 is chlamydia.
What are the sonographic features of orchitis? 2
Sonographic features include
1. Hypoechoic areas adjacent to enlarged epididymis
2. Decreased echogenicity of the entire testicle.
What is an abscess in relation to epididymo-orchitis?
An abscess is a common complication of untreated epididymo-orchitis and is considered a surgical emergency.
What are the signs and symptoms of an abscess? 3
Signs and symptoms include
1. Pain
2. Fever
3. Swollen scrotum.
What are scrotal pearls?
Scrotal pearls are calcifications floating on the tunica or within the scrotal sac.
What is a spermatocele?
A spermatocele is a retention cyst filled with nonviable sperm, typically located at the epididymal head.
What are the sonographic features of a spermatocele? 3
Sonographic features include a
1. Well-defined
2. Anechoic mass
3. Acoustic enhancement.
What are true cysts in the scrotum?
True cysts are filled with serous fluid and are typically asymptomatic.
What are non-germ cell neoplasms?
Non-germ cell neoplasms are mostly benign tumors that represent less than 5% of testicular tumors.
What is an adenomatoid tumor? How common is it? Where is it typically found?
- An adenomatoid tumor is a benign tumor
- The most common extratesticular tumor
- Typically found in the epididymis.
What is microlithiasis?
Microlithiasis refers to calcifications in the seminiferous tubules, with isolated microlithiasis being common.
What is the significance of more than 5 calcifications in microlithiasis?
More than 5 calcifications per transducer field has a strong association with the development of malignant neoplasms.
What are the characteristics of malignant pathologies in the scrotum?
Malignant pathologies typically present as painless scrotal enlargement or hardness of the testicle.
What is the most common germ cell tumor?
The most common germ cell tumor is seminoma.
What is the prognosis for seminomas?
Seminomas are the least aggressive germ cell tumors and have the best prognosis.
What are non-seminomatous germ cell tumors?
Non-seminomatous germ cell tumors are more aggressive and can develop visceral metastases.
What is embryonal cell carcinoma?
Embryonal cell carcinoma is the second most common germ cell tumor and is the most aggressive tumor.
What is choriocarcinoma?
Choriocarcinoma is an uncommon, highly malignant tumor with a poor prognosis.
What characterizes teratomas?
Teratomas can be benign in children and malignant in adults, with cystic and solid components.
What is a ‘burned-out’ tumor?
A ‘burned-out’ tumor is a tumor that has regressed but may still have residual effects.
What are the common metastatic tumors of the testes?
The most common metastatic tumor of the testes is lymphoma.
What are the common changes seen post-vasectomy?
Post-vasectomy changes may include epididymal enlargement, heterogeneous appearance, and sperm granulomas.
What are idymis and rete testis?
Variable sized cystic lesions seen in the region of the mediastinum and epididymis.
May be mistaken for a neoplasm.
What is a characteristic of idymis and rete testis regarding color flow?
They show no color flow.
Are idymis and rete testis typically unilateral or bilateral?
They are frequently bilateral and asymmetrical.
What is often associated with idymis and rete testis?
They are often associated with a spermatocele.
What should be assessed in the scrotal space post orchiectomy? 3
Assessment of scrotal space for
1. Hematomas
2. Abscesses
3. Recurrent neoplasms
4. Prosthesis.
