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99 Cards in this Set
- Front
- Back
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A normal testicle measures less than ___ x ___ x ___ with volume of ___ ml.
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5x3x3
15-20mL |
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Testicular size increases/decreases with age
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decreases
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The seminiferous tubules converge to form the ___ ___, which are located at the testicular mediastinum.
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rete testes
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What is the sonographic appearance of the testicular mediastinum?
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peripherally located
elongated hyperechoic Middleton 153 Fig 6-1 A/B |
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What connects the rete testes to the epididymal head?
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efferent ductules
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How does the echogenicity of the head of the epididymis compare to the testis?
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same echogenicity
Middleton 153 Fig 6-1C |
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How does the echogenicity of the body and tail of the epididymis compare to the testis?
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body and tail of epididymis is less echogenic than the testis
Middleton 153 Fig 6-1 D/E |
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What is the location of the epididymis?
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anterolateral or posterior aspect of the testes
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Unlike other organs, the major arteries of the testis are located centrally/peripherally and are called ___ arteries
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peripherally
capsular arteries Middleton 154 Fig 6-2 |
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Capsular arteries branch into ___ arteries, which reflect near the mediastinum to ___ ___
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centripital arteries reflect into recurrent rami
Middleton 154 Fig 6-2 |
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In ___% of testes one or more major branches of the testicular artery enter the testis through the mediastinum. A transmediastinal vein may travel with it.
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50%
Middleton 154 Fig 6-2 |
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What is the resistance pattern of the testicular arterial waveform
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low resistance
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Is blood flow normally seen in the epididymis?
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Not always, but it should at least be less vascular than the testis
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What is the sonographic appearance of a spermatocele?
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cystic lestions in the head of the epididymitis
Middleton 154 Fig 6-3 |
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What is the location of an epididymal cyst?
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head, body, or tail of the epididymis. similar sonographic appearance to spermatocele, but alternate locations in body and tail are possible.
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Spermatoceles are extremely common, and seen in more than __% of testicular scans
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70%
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What is the sonographic appearance of a hydrocele?
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Hypoechoic, unless small x-tals ppt in the fluid and create low-level echoes
Usually displace the testis posteriorly Middleton 155 Fig 6-4 |
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Hydroceles develop in the potential space of the ___ ___
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tunica vaginalis
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What is the name of a hydrocele that develops in the spermatic cord?
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funiculocele or hydrocele of the cord
Middleton 155 Fig 6-4D |
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A hydrocele that is complicated by infection is called a ___ and one that is complicated by hemorrhage is called a ___
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pyocele
hematocele Middleton 156 Fig 6-5 |
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A pyocele commonly has a thin/thick and hyperemic scrotal wall surrounding it.
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thick and hyperemic
Middleton 156 Fig 6-5 |
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What is the sonographic appearance of a varicocele?
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numerous, dilated, tortuous, tubular channels in the peritesticular tissues
lateral, posterior, or superior to the testis Middleton 156 Fig 6-6 |
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What causes a varicocele?
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dilated peritesticular veins due to incompetent valves in the spermatic veins
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Why are 85% of varicoceles L sided and 15% bilateral?
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The SMA crosses over the L renal vein, which the L testicular vein drains into. This can compress and cause a mechanical obstruction.
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If you see a R-sided varicocele or R>L varicocele, what should you do?
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look situs inversus or retroperitoneal mass
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Are varicoceles usually painful?
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no
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What is a complication of varicoceles?
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infertility, even small varicoceles.
that is why testicular US is part of the infertility w/u |
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How can you augment vascular flow to a varicocele (blood flow is usually not evident without performing this maneuver)?
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Valsalva, especially while standing, should produce persistent (>1sec) Valsalva-augmented venous flow
You will get flow reversal during Valsalva Middleton 157 Fig 6-7 |
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What is the ULN for scrotal veins?
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2mm
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What is the name of the venous plexus around the testicle?
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pampiniform plexus
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Name 4 factors that decrease the chance of a scrotal lesion being a neoplasm
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extratesticular
nonpalpable simple cystic appearance no detectable vascularity |
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Name 4 factors that increase the chance of a scrotal lesion being a neoplasm
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intratesticular
palpable solid or complex cystic detectable internal vascularity |
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What is the sonographic appearance of a scrotal hematoma?
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variable
complex, fluid collection with internal membranes - evolving hematoma after hernia repair Middleton 157 Fig 6-8 |
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What is the sonographic appearance of a hernia?
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target appearance
peristalsis compression and Valsalva can help to diagnose Middleton 158 Fig 6-9 |
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What is the sonographic appearance of scrotal edema?
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markedly thickened scrotal wall
Middleton 158 Fig 6-10 |
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What is the sonographic appearance of a scrotolith?
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small, shadowing calcification along the scrotal wall
Middleton 158 Fig 6-11 |
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What is the sonographic appearance of a testicular cyst?
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small
commonly adjacent to the mediastinum NOT palpable Middleton 159 Fig 6-14 |
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What should you do for a simple intratesticular cyst?
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nothing, if it has a benign appearance
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Unlike simple testicular cysts, complex cystic tumors are usually ___
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palpable
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What is a simple testicular cyst that is very firm and easily palpable? It is located peripherally.
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tunica albuginea cyst
Middleton 159 Fig 6-15 |
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Even though a tunica albuginea cyst is palpable, do you need to f/u with further studies?
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no, if it is a small, simple cyst
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What is the sonographic appearance of tubular ectasia of the rete testes?
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tiny cystic appearing changes replace the mediastinum
usually bilateral, although not necessarily symmetric in appearance Middleton 160 Fig 6-16 |
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Does tubular ectasia of the rete testes require f/u?
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no
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With what is tubular ectasia of the rete testes associated?
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spermatoceles and intratesticular cysts
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What is the most common testicular neoplasm in young adult men?
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germ cell tumor
specifically, seminoma |
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How does a germ cell tumor most commonly present?
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nontender palpable mass
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What are the most common germ cell tumors?
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pure seminoma
mixed germ cell tumors |
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What are some types of germ cell tumors?
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seminoma
embryonal cell teratoma choriocarcinoma yolk sac mixed germ cell tumor Middleton 160 Box 6-2 |
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What are 2 types of stromal tumors?
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Leydig cell tumor
Sertoli cell tumor |
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What is the sonographic appearance of a typical seminoma?
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hypoechoic
homogenious smooth walls Middleton 161 Fig 6-17 |
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What is the prognosis of a seminoma
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good
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What is the sonographic appearance of a nonseminomatous mixed germ cell tumor?
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heterogenous
calcifications cystic elements Middleton 161 Fig 6-18 |
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How does the vascularity of a testicular tumor usually compare to normal testicle?
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a tumor is hypervascular
Middleton 162 Fig 6-19 |
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If you suspect a germ cell tumor on a scan of the testicle, where else should you look?
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The retroperitoneum, near the level of the kidneys, to look for nodal metastasis
Middleton 163 Fig 6-20 |
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If you find retroperitoneal adenopathy in a young adult male, where else should you look?
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the testes, to look for occult tumor
Middleton 163 Fig 6-20 |
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Non-germ cell tumors account for about ___-___% of testicular tumors
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5-10%
Leydig and Sertoli cell tumors Middleton 163 Fig 6-21 |
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Why are non-germ cell tumors always removed?
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they produce hormonal changes and they cannot be distinguished from malignant germ cell tumors
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Is an epidermoid cyst benign or malignant?
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benign
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What is the sonographic appearance of an epidermoid cyst?
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hypoechoic mass with a hyperechoic calcified rim or multple concentric internal laminations that simulate an
"onion slice" Middleton 164 Fig 6-22 |
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What is the most common cause of testicular tumor in the elderly?
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metastatic disease
Middleton 164 Fig 6-23 |
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T/F
Because chemotherapy does not cross a blood-testis barrier, the testes can serve as a sanctuary for lymphoma and leukemia when the pt's disease is in remission elsewhere in the body. |
true
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Sonography is ___% sensitive in detecting testicular tumors
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95-100%
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What is the sonographic appearance of testicular atrophy and fibrosis?
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hypoechoic lines that arranged in a linear pattern producing a striated appearance, and radiate from the mediastinum
look in multiple planes to avoid mis-diagnosing a mass! Middleton 166 Fig 6-26 |
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How can you differentiate a non-neoplastic lesion from a neoplasm?
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neoplasms are usually very vascular
Middleton 165 Fig 6-24 and 6-25 |
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What is the sonographic appearance of microlithiasis?
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>5 lesions in an image
bright reflectors no acoustic shadowing Middleton 167 Fig 6-27 |
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What is the sonographic appearance of limited testicular microlithiasis?
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<5 lesions per image
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___% of pts with microlithiasis will have a testicular germ cell tumor at the time of initial US exam
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10%
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If a pt presents with microlithiasis in their testicles and a tumor in only one testicle, what intervention should be done?
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At the time of orchiectomy, a biopsy of the unaffected testicle has a high likelihood of having abnormal histology
Middleton 167 Fig 6-28 |
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What is the sonographic appearance of a tunica albugenia or tunica vaginalis fibrous plaque?
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calcified or uncalcified plaque along the wall
Middleton 168 Fig 6-29 |
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The risk of germ cell tumor is ___X that of the normal population if an undescended testicle is not surgically corrected by age ___ yrs.
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40 times
5 years |
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___% of undescended testicles are found in the inguinal canal and ___% are in the retroperitoneum.
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80% inguinal canal
20% retroperitoneum Middleton 168/9 Fig 6-30/31 |
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What is the first hemodynamic consequence of testicular torsion?
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venous obstruction, shortly followed by arterial obstruction and testicular ischemia
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The viability of the torsed testicle depends on what 2 factors?
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duration of torsion
number of twists |
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Testicular salvage is likely if surgery on a torsed testicle is performed before ___ hours
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6 hours
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Why are the gray scale findings of testicular torsion important?
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If present, testicular salvage is unlikely
If absent, testicular salvage is likely |
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What are the B-mode findings associated with testicular torsion?
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hypoechoic
testicular swelling reactive hydrocele thickening of the scrotal wall torsion knot Middleton 170 Fig 6-32 |
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What are the Doppler findings of torsion?
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decreased venous, then arterial vascularity
arterial waveform is blunted with delayed upstroke Middleton 171 Fig 6-33 |
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What can produce a false-negative testicular torsion US exam?
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intermittent torsion
low grade torsion |
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What is the sonographic appearance of epididymitis?
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enlarged
hypoechoic hyperemic diffuse or focal (look through entire epididymis!) small abscesses may be present (no Doppler flow) Middleton 172 Fig 6-34 |
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Orchitis usually occurs in conjunction with ___
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Epididymitis
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What is the sonographic appearance of orchitis?
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enlarged
hypoechoic increase vascularity it should be followed to resolution to ensure that it is not an occult neoplasm Middleton 173 Fig 6-35 |
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Orchitis is less/more frequently focal than epididymitis?
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less
orchitis is more likely to be diffuse |
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How can one differentiate focal orchitis from a hypervascular tumor?
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clues include: pain, tenderness, no palpable mass, epidydimal involvement
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What is the sonographic appearance of a testicular abscess (a complication of untreated orchitis)?
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hyperemia surrounding the abscesses
Middleton 174 Fig 6-36 |
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What is the sonographic appearance of testicular rupture?
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heterogenous due to extrusion of blood and fluid from seminiferous tubules
decreased blood flow misshapen testicle Middleton 175 Fig 6-38 |
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What is the clinical importance of diagnosing testicular rupture?
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If the tunica albuginea is violated, surgery within 72 hours may save the testicle.
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Why should testicular US be a routine part of trauma evaluation?
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Detect testicular rupture
Trauma increases the incidence of torsion |
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What muscle is in the scrotal wall?
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cremaster muscle
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What divides the scrotum into 2 parts?
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median raphe
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The epididymis connects to the ___ ___, which courses through the spermatic cord
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vas deferens
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The vas deferens connects with the ___ ___ and the ejaculatory duct of the prostate
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seminal vesicles / seminiferous tubules
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While the ___ artery supplies the testicle, the ___ artery supplies the vas deferens and epididymis, and the ___ artery supplies the paratesticular tissue
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testicular artery
deferential artery cremasteric artery (branch of the inferior epigastric artery) |
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The HCG level can be elevated with what kind of germ cell tumor?
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choriocarcinoma
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What changes about the sperm with some varicoceles?
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sperm count decreases
hypomotile sperm |
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What is cryptorchism
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undescended testicle
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What are 2 complications of cryptorchism?
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infertility
testicular cancer risk increases |
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Testicular metastasis usually originate from what?
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leukemia
non-Hodgkin's lymphoma |
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What are some causes of hydrocele?
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idiopathic
trauma epididymo-orchitis testicular torsion iatrogenic factors |
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Untreated orchitis can lead to testicular ___
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infarction
abscess |
