Scrotum/prostate/penis Flashcards by Ty Christensen

Testis measure

3-5cm x 2-4cm x 3cm

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Tubules converge at the apex of each lobule and anastomose to form the _____ in the mediastinum

Rete testis

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Each testis divides into >250-400 conical lobules containing the ____

Seminiferous tubules

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Testis appear sonographically

Smooth, medium gray, fine echo texture

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Rete testis drains into the ____

Head of the epididymis

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Rete testis drains into the head of the epididymis through ___

Efferent ductules

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Epididymis begins _____ and courses _____ to testis

Superior

Posterolateral

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Largest part of epididymis

Head

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Normal epididymis appears

ISO/hypoechoic compared w testis, coarser texture

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Dense fibrous tissue that covers the testis

Tunica albuginea

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Mediastinum often seen as ______ line coursing craniocaudad within testis

Bright hyperechoic

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Lines inner walls of scrotum and covers testis & epididymis

Tunica vaginalis

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Inner layer of scrotal wall

Parietal layer

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Layer surrounding testis and epididymis

Visceral

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Form in space between layers of tunica vaginalis

Hydroceles

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Spermatic cord contains:

Vas deferens

Testicular arteries

Venous pampiniform plexus

Lymphatic

Autonomic nerves

Fiber of cremaster

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Testicular arterial branching:

Testicular
Capsular
Centripetal
Recurrent rami

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Venous drainage of scrotum occurs through

Pampiniform plexus

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Pampiniform plexus converges into 3 sets of anastamotic veins:

Testicular
Deferential
Cremasteric

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Right testicular vein drains into

IVC

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Left testicular vein drains into

Left renal vein

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Perform ______ when varicocele is suspected

Valsalva maneuver

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90% of testes can be saved if surgery is performed within _____ hours following injury

72 hours

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Only ___ can be saved after 72 hours post injury

45%

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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?

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