Scrotum/prostate/penis Flashcards
Testis measure
3-5cm x 2-4cm x 3cm
Tubules converge at the apex of each lobule and anastomose to form the _____ in the mediastinum
Rete testis
Each testis divides into >250-400 conical lobules containing the ____
Seminiferous tubules
Testis appear sonographically
Smooth, medium gray, fine echo texture
Rete testis drains into the ____
Head of the epididymis
Rete testis drains into the head of the epididymis through ___
Efferent ductules
Epididymis begins _____ and courses _____ to testis
Superior
Posterolateral
Largest part of epididymis
Head
Normal epididymis appears
ISO/hypoechoic compared w testis, coarser texture
Dense fibrous tissue that covers the testis
Tunica albuginea
Mediastinum often seen as ______ line coursing craniocaudad within testis
Bright hyperechoic
Lines inner walls of scrotum and covers testis & epididymis
Tunica vaginalis
Inner layer of scrotal wall
Parietal layer
Layer surrounding testis and epididymis
Visceral
Form in space between layers of tunica vaginalis
Hydroceles
Spermatic cord contains:
Vas deferens
Testicular arteries
Venous pampiniform plexus
Lymphatic
Autonomic nerves
Fiber of cremaster
Testicular arterial branching:
- Testicular
- Capsular
- Centripetal
- Recurrent rami
Venous drainage of scrotum occurs through
Pampiniform plexus
Pampiniform plexus converges into 3 sets of anastamotic veins:
- Testicular
- Deferential
- Cremasteric
Right testicular vein drains into
IVC
Left testicular vein drains into
Left renal vein
Perform ______ when varicocele is suspected
Valsalva maneuver
90% of testes can be saved if surgery is performed within _____ hours following injury
72 hours
Only ___ can be saved after 72 hours post injury
45%
Acute hematocele appears
Echogenic
Old hematoceles appear
Low level echoes, fluid filled, septations
Hematomas appear
Heterogeneous, may be complex and cystic over time
Vascularity associated with epididymitis
Increased vascularity
Most common cause of scrotal pain in adults
Epididymo-orchitis
Epididymo-orchitis most commonly results from
Lower uti spread via spermatic cord
Sonographic appearance of epididymitis
Enlarged, hypoechoic gland
With epididymis-orchitis, color Doppler will show
Significant increased flow
Hydroceles are found around ____ aspect of testis
Anterolateral
Pus fills space between layers of tunica vaginalis
Pyocele
Deformity associated with torsion
Bell-clapper
Occurs when tunica vaginalis completely covers testis, epididymis, distal spermatic cord, allowing them to rotate/move
Bell-clapper deformity
Undescended testes are _____ times more likely to be affected by torsion
10 times
Up to ___ % of torsion patients have an atomic anomaly on both sides
60%
80-100% of testes can be saved if surgery is performed within ____ after onset of pain(torsion)
5-6 hours
Surgery for torsion between 6-12 hours after onset of pain salvage rate:
70%
Salvage rate after 12 hours of onset of pain involving torsion
20%
Most common cause of acute scrotal pain in adolescents
Torsion
Extratesticilar cysts include:
Spermatoceles, epididymis cysts, tunica albuginea cyst
Spermatoceles are always located in the
Epididymal head
Abnormal dilation of veins of pampiniform plexus
Varicoceles
Varicoceles are more common on ____
left side
Varicoceles are also associated with
Infertility
Varicoceles measure:
> 2mm in diameter
During the valsava maneuver the veins:
Increase in diameter
Most commonly herniated structure
Bowel and then omentum
_______ seen with real-time imaging, this confirms scrotal hernia
Peristalsis of bowel
Most common cause of painless scrotal swelling
Hydroceles
Sperm granulomas are most frequently seen in patients with
Vasectomy
Rete testis is located at the
Hilum of testis where the mediastinum resides
Tubular Ectasia of the Rete Testis appears :
Prominent hypoechoic channels near the echogenic mediastinum testis, avascular
Tubular ectasia of the rete testis usually occurs in
Men over 55
Cysts are more common in
Men >40
Microcalcifications in microlithiasis are how big?
<3mm
Microlithiasis is bilateral or unilateral?
Bilateral
Associated with cryptorchidism, klinefelters syndrome, infertility, varicoceles, testicular atrophy, male pseudohermaphroditism
Microlithiasis
Most common malignancy in men 15-35
Germ cell tumor
Undescended testis are ____ more likely to develop cancer
2.5-8 times
Intratesticular masses are more/less likely to be malignant?
More
Associated with elevated HCG, AFP, LDH
Germ cell tumors
Most common germ cell tumor
Seminoma
When a seminoma is suspected, sonographer should
Inspect around aortas lymph nodes
Germ cell tumors appear
Focal, hypoechoic
Seminomas appearance
Homogeneous, hyooechoic, smooth border
Most common bilateral secondary testicular neoplasm affecting men >60
Malignant Lymphoma
2nd most common secondary testicular neoplasm, most often found in children
Leukemia
Undescended testicle
Crytorchidsm
Involving cryptorchism, testis are usually found in ____
Inguinal canal
Most common site for ectopic testicle
Superficial inguinal pouch
Anorchia is more common on the ___ side
Left
Polyorchidism is more common on the ____ side
Left
3 columns of tissue in penis
2 corpora cavernosa
1 corpus spongiosum
Ventral/anterior side of penis:
Closest to scrotum
Dorsal/posterior side of penis
Side touching belly
Painful erection lasting >4 hours
Priapism
Fibrotic thickening/scarring of the tunica albuginea resulting in bent penis—hyperechoic linear, calcified, shadowing
Peyronie’s disease
Prostate base:
Superior portion
Prostate apex:
Inferior portion
Zone containing 70% of prostrate tissue
Peripheral
Zone location of most prostate cancer
Peripheral zone
Peripheral zone is located ___
Posteriorly
2nd largest zone
Central
Central zone is located
Superiorly at the base or prostate
Ejaculatory ducts pass through what zone
Central
2nd most common zone for malignancy
Transitional
Site of origin of benign prostatic hyperplasia (BPH)
Transitional
Smallest zone
Periurethral
Classic appearance of prostate cancer
Hypoechoic, hypervascular, peripherally-oriented
Clinical signs of prostate cancer
Elevated PSA
Enlarged prostate
Blood in urine
Enlargement of transitional zone:
Benign Prostatic Hyperplasia
Clinical signs of Benign Prostatic Hyperplasia
Difficult initiation of voiding
Urinary frequency
Small stream