Testicular Flashcards
What are epididymal cysts?
Serous fluid-filled cysts that occur anywhere in the epididymis
They can be palpable if large enough and are separate from the testicle.
What is a spermatocele?
Cystic dilatations of the epididymal ductules containing spermatozoa and debris, usually occurring in the head
Spermatocele is often solitary, while epididymal cysts are often multiple.
What is a hydrocele?
Abnormal amount of serous fluid in the peritesticular space
It can be unilateral or bilateral and can occur at any age.
What are the causes of hydrocele?
- Trauma
- Infection
- Infarction
- Torsion
- Testicular neoplasm
What are the sonographic findings of a hydrocele?
Fluid collection next to or around the testis, sometimes with septations
May compress the testis against the inner scrotal wall.
What is a varicocele?
A network of dilated veins (pampiniform plexus) due to increased venous pressure
Predominantly found on the left side.
What are the sonographic findings of a varicocele?
Dilated fluid-filled tubular structures in the posterolateral aspect of the scrotum measuring greater than 2mm
Increased blood flow with Valsalva maneuver.
What is a hematocele?
Collection of blood in the peritesticular space
Considered in patients with a history of recent trauma, torsion, or surgical procedures.
What are the sonographic findings of a hematocele?
Complex fluid collection around the testes with possible septations
Varying amounts of cystic vs solid contents depending on the age of the hematoma.
What is a pyocele?
Enlarged scrotum with pain, redness, localized warmth, elevated WBC count, and low-grade fever
Sonographic findings include complex, sometimes septated fluid collection surrounding the testis.
What are scrotal pearls?
Calcifications within the peritesticular space
Sonographic findings are highly echogenic with possible concentric rings.
What is an adenomatoid tumor?
A very commonly found solid mass in the epididymis, benign in nature
Typically hard, discrete extratesticular nodule usually at the tail.
What is a scrotal hernia?
Inguinal hernias that enter the scrotum, possibly containing serous fluid, small bowel, colon, mesentery, or omentum
There are two types: direct and indirect, with indirect being more common.
What is the significance of differentiating solid vs cystic masses in the scrotum?
Every solid intratesticular mass must be considered malignant until proven otherwise
Scrotal ultrasound approaches 100% accuracy in distinguishing solid from cystic masses.
What is a tunica albuginea cyst?
Cysts that form in the tunica albuginea, typically found in men aged 30 to 50
They present as painless and palpable at the testicular surface.
What defines a testicular cyst?
Cysts seen within the testicle considered ‘true cysts’, likely originating in the rete testis
They can be tiny or replace entire testicular tissue.
What is an epidermoid cyst?
Benign keratin-containing cysts, accounting for 1% of testicular neoplasms
They have an ‘onion skin’ appearance and are painless.
What are germ cell tumors?
Most solid intratesticular masses are malignant, including seminomatous and nonseminomatous types
They are usually painless and often present in younger individuals.
What is a seminoma?
The most common germ cell tumor, accounting for about half of testicular tumors
They metastasize to retroperitoneal lymph nodes and respond well to treatment.
What is embryonal cell carcinoma?
The second most common testicular cancer, typically found in individuals aged 20 to 40
More aggressive than seminomas and can metastasize through bloodstream or lymphatics.
What is a teratoma?
Tumors containing teeth, hair, bone, and other tissues, usually benign in younger patients
There is a 30% malignancy rate in older patients.
What is choriocarcinoma?
The rarest of germ cell carcinomas, typically seen in ages 10 to 30
Elevated levels of HCG often lead to gynecomastia.
What is a Leydig cell tumor?
Also known as interstitial cell tumors, making up 15% of malignant testicular cancers
They typically present as a painless enlargement or palpable mass.
What is a Sertoli cell tumor?
Usually benign tumors that can occur at any age, presenting as a large painless palpable mass
Sonographic findings are similar to Leydig cell tumors.
What is cryptorchidism?
Absence of one or both testicles from the scrotum, with 80% palpable in the inguinal canal
Associated risks include infertility, cancer, and scrotal hernia.
What are the common causes of scrotal pain?
Inflammation or torsion
Often results from retrograde progression of a urinary tract infection or trauma.
What is torsion?
Occurs when the testis rotates within the scrotum, twisting the spermatic cord
Sudden severe pain can occur, especially during strenuous activity or sleep.
What are the sonographic findings in testicular torsion?
Enlarged hypoechoic testis with diminished high-resistance arterial flow
The ‘whirlpool sign’ is often observed posterior to the testicle.
What is a testicular hematoma?
Bleeding within a testicle, presenting as a painful scrotum
It may show heterogeneous appearance with possible septations.
What is a testicular infarct?
Occurs after focal or diffuse ischemia of the testicle
Typically presents with a focal hypoechoic mass.
What is testicular rupture?
A condition where the tunica albuginea is ripped or cut due to trauma
It is a urologic emergency with a 90% salvage rate if treated surgically.
What is the primary imaging technique used for testicular screening?
Ultrasound
Ultrasound is the primary tool for testicular screening for most pathologies.
What structures are contained within the scrotum?
- Testicles
- Epididymides
- Spermatic cords
These structures are essential for male reproductive function.
What is the normal size of the testicle?
Approximately 5cm x 3cm x 2cm
This size is used as a reference for normal testicular anatomy.
What is the echogenicity of the testicle on ultrasound?
Homogeneous and mildly echogenic
The mediastinum testis appears hyperechoic.
What is the anatomy of the epididymis divided into?
- Head
- Body
- Tail
The epididymis is a tubular structure that courses posterior-lateral to the testis.
What is the typical length of the epididymis?
6cm – 7cm
The head of the epididymis may be more echogenic than the rest.
Where is the head of the epididymis located?
Superior to the upper pole of the testicle
The head is the largest part of the epididymis, measuring 6mm to 15mm in width.
What arteries provide blood flow to the testicle?
- Testicular arteries
- Capsular arteries
- Centripetal arteries
- Centrifugal arteries
These arteries originate from the abdominal aorta and provide vital blood supply to the testes.
What is the appearance of centrifugal arteries on color Doppler exam?
Candy cane appearance
This appearance is due to the branching of the arteries into arterioles and capillaries.
What are some pathologies that can be detected with a testicular ultrasound?
- Inflammatory processes of the testes & epididymis
- Tumors
- Trauma
- Torsion
- Hydrocele
- Varicocele
- Hernias
- Spermatoceles
- Undescended testes
These pathologies can affect testicular health and require thorough evaluation.
What should be the appearance of the testicular parenchyma on ultrasound?
Uniform with equal echogenicity bilaterally
This indicates normal testicular health.
What planes should the ultrasound scan be conducted in for the testicles?
- Sagittal
- Transverse
Scanning in two planes helps in accurate measurement and evaluation.
What is the purpose of using Color Doppler in testicular ultrasound?
To assess blood flow
Color Doppler should be applied to both testicles for a comprehensive evaluation.
True or False: The peritesticular space normally contains a large amount of serous fluid.
False
The peritesticular space normally contains a small amount of serous fluid.
What is the measurement process for testicles during an ultrasound?
Measure in mid plane in both sagittal & transverse
This ensures consistent and accurate size assessment.
Fill in the blank: The tunica albuginea is _______.
[a fibrous connective tissue encapsulating the testicles]
This structure provides support to the testicles.
