Testicular Flashcards
What is the appendix epididymis
A detached efferent duct. It’s seen as a small soft projection off the epididymis.
What is the appendix testis
Ruminant of the mullerian duct. A small ovoid structure near head of epididymis.
What is the tunica albuginea and tunica vaginalis
Albuginea: fibrous capsule that surrounds the testicle
Vaginalis:
the inner/visceral layer. It covers the testicle and epididymis.
The outer/parietal layer lines the walls of the scrotal chamber. A small amount of fluid is commonly seen in this space.
Hydrocele
Collection of fluid in tunica vaginalis
Fluid collection surrounding the testicle.
Congenital/acquired
MC fluid collection in scrotum
MC in newborns
Idiopathic, trauma, infection, infarct, torsion, neoplasm
Fluid collection, enhancement, wall thick, scrotal pearls, septations with old hemorrhage/infection
Varicocele
Dilated tortuous veins of the pampiniform plexus located posterior to the testis and assoc with male infertility.
Caused by incompetent valves of the internal spermatic vein
MC on left, distend when valsalva or abd compression
Pamp plexus > 2 mm
Infertility, warm temp scrotum, tubular serpiginous veins, > 2 mm, inc with valsalva in upright position.
Difference between epididymal cyst and spermatocele
Both result from dilatation of the epididymal tubules
Epi cyst are composed of clear fluid.
Spermatoceles are filled with thick milky fluid containing spermatozoa
2 MC causes of acute scrotal pain
Torsion, epididymalorchitis
Torsion of spermatic cord
Enlg hetero and hypo when compared to contralateral testis
Enlg epididymis, skin thickening, reactive hydrocele
Prescience of blood flow does not exclude partial torsion
At least 540 degrees of torsion is necessary to completely occlude testicular blood flow.
Acute epididymitis
Enlg Epi, dec echoes, hetero, hydrocele, skin thickening
Cryptorchidism / undescended testicle
At or below inguinal canal
May cause infertility or cancer
2 complications of undescended testicle
Infertility and inc risk of cancer even on the normal testicle with an orchiopexy
Orchiopexy
Surgery to move undescended testicle into scrotum
Hematocele
Blood collection in tunica vaginalis
Trauma
Pyocele
Pus collection in tunica vaginalis
Infection
Echogenic debri
Endocrine
Testosterone (sex hormones)
Exocrine
Spermatogenesis
Spermatic cord
Arteries veins nerves lymphatics vas deferens
Vas deferens connects epididymis to seminal vesicles.
Blood supply
Testicular artery, cremasteric artery, deferential arteries
Pampiniform plexus-> spermatic vein -> ivc on rt and left renal vein to ivc on left.
Sperm travels
Epididymis Vas deferens Seminal vesicles Ejaculatory Duct Urethra
Epididymis
Stores sperm
Layers
Tunica vaginalis: double sac covering testis, prevents abdomen contents from herniating into sac
Tunica albuginea: fibrous capsule covering testis
Mediastinum: invagination of tunica albuginea. Echogenic line
Appendix testis: fibrous band sup to testis
Testis & epididymis meas
Testis 3-5 cm L, 2-4 W, 3 AP
Scrotal wall 2-8 mm
Epi head 6-15 mm, body 2-4, tail 2-5 mm
Epididymis
Head / Globus Major
Body / Corpus
Tail / Globus Minor
Patients with vasectomy, inc size of epi & may see cyst
Congenital Anomalies
Testicular Ectopia
Anorchia: rare, only 1 testis, vasc problem in utero
Polyorchidism: very rare
Rupture
Torn capsule, rare, assoc with trauma, early dx & tx critical
Irreg capsule, Hematocele, intratesticular hematoma/infarct, wall thick, absent/dec flow, liquefaction after 3 days
Torsion
Twisting of testis. “Bell clapper” deformity.
Young males
Resting
Severe sudden pain, when at rest, n/v, radiating pain, may mimic epididymitis.
5-6 hrs can save.
Absent Doppler, inc size, hypo/hetero, skin thickening, hydrocele, necrosis/hemorrhage/infarct
Chronic: small hypo testis, large epi
Epididymitis
Inflammation of epi.
Bacterial, trauma, idiopathic
Focal or diffuse (head body tail)
Can lead to epididymalorchitis and abscess
Fever, pain urine, tense tender epi/scrotum, Palp hard cord
Skin thickening, hydrocele
Acute: enlg epi, hypo, hypervascular
Chronic: hyper, ca+
Spermatocele
Retention cyst of sperm containing tubules
MC in epi head
Cystic mass, displace testis ant, septations, indistinguishable from
Epididymal cyst
Spermatocele more common than epididymal cyst & is milky fluid
Scrotal hernia
Inguinal hernias descended into scrotum.
Assoc with patency of vaginalis and heavy lifting.
Extratesticular mass, bowel, peristalsis unless bowel stuck.
abd pain, blood in stool, constipation
Granulomatous Disease
TB spread, unilateral, initially involves epi but can spread to testis.
Acute: focal hypo mass
Chronic: blending of epi and testis. Ca+
Scrotal Calcifications
Benign
Assoc with inflammation, tb, vasc ca+, cryptorchidism, klinefelters, sterility, tumors
Microlithiasis
Benign
Assoc with infertility, Cryptorchidism, neoplasm
Tiny Echogenic foci, don’t shadow, well disseminated
Tunica Albuginea Cyst
Rare, 2-5 mm
Cyst ant/lat to testis
Epididymal Cyst
Dilated epi tubules
Less common than spermatocele. Clear fluid.
Testicular cyst
Benign
More common in upper pole
Epidermoid cyst
Benign, germ cell origin
Well defined, Echogenic cyst walls/halo, cystic/hypo, homo, ca+
Adenomatoid Tumor
Benign Extratesticular
Usually in epi, asymptomatic, uni, left. More common than Leiomyoma
Hypo/hyper, well described, assoc hydrocele
Leiomyoma
Benign Extratesticular tumor
Less common than adenomatoid tumors
Extratesticular malignant neoplasms
Fibrosarcoma
Liposarcoma
Rhabdomyosarcoma (peds)
Solid, I’ll defined, hetero, complex with necrosis
Intratesticular tumors
Most are malignant.
Leydig cell tumor is MC benign but can turn malignant.
Benign intratesticular tumors
Leydig cell tumor: MC, malignant potential Sertoli Tumors Dermoid cyst Cystadenomas Adenomatoid tumors
Leydig Cell Tumor / interstitial cell tumor
MC non germ cell, benign. Malignant potential.
Endocrine imbalance, impotence (erectile dysfunction), Gynecomastia (inc Breast tissue), dec libido
Testicular cancer
Young, painless mass, unilateral enlargement. 10% with acute pain
Focal mass, hypo, mixed echoes, hetero, inc vascularity
Malignant tumors
Seminoma Embryonal cancer Choriocarcinoma Teratoma Teratocarcinoma Mets
Seminoma
MC testicular cancer
30% hx of cryptorchidism
Encapsulated
25% with mets
Embryonal Cell Carcinoma
Second MC
Aggressive
Cystic necrosis
Choriocarcinoma
Inc HCG
Mixed echo
Highly malignant
Least common
Teratoma
Infants & children
Malignant or benign
Ca+
Mixed tumors
Teratocarcinoma MC
Has teratoma/embryonal cells
Aggressive
Complex mass
Mets to testis
Rare
Prostate and kidneys MC
Multiple bilateral hypo
Lymphoma & Leukemia
Infiltration to testis
