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45 Cards in this Set
- Front
- Back
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What is a spermatocele? |
- benign cysts containing nonviable sperm - most commonly caused by obstruction - cannot be differentiated from simple epididymal cysts |
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Where are spermatoceles located? |
in the head of the epididymis |
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What is the reason for ultrasound of the scrotum? |
- it is nearly 100% accurate in the detection of scrotal pathology - high accuracy in differentiating a cystic mass from a solid one - the use of color flow Doppler is nearly 100% in the diagnosis of torsion |
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What is the mediastinum of the testicle? |
- where the ducts and vessels enter and exit the testicle - it is an echogenic line within the testicle running craniocaudal direction |
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What is a hydrocele? |
- abnormal collection of serous fluid in the potential space between the two layers of the tunica vaginalis - unilateral or bilateral |
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What are some causes of secondary hydrocele? |
- trauma - infection - chronic or missed torsion - neoplasm |
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What is the sonographic appearance of hydrocele? |
- unilocular or multilocular sonolucent area with good through transmission surrounding the testis - thick or irregular septations suggest previous hemorrhage or infection |
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What is a varicocele? |
- dilated and elongated veins of the pampiniform plexus - more commo in the left but can be bilateral (left spermatic vein drains into the left renal vein at a 90-degree angle; this angle prevents formation of a valve) - they are the result of retrograde venous flow back into the pampiniform plexus |
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Explain right sided varicoceles. |
- usually associated with some underlying abnomality Two categories: - Primary: more common in younger individuals, thought to be caused by incompetent valves in left testicular vein - Secondary: develop from compression of the spermatic vein or its tributaries |
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What is the most common cause of infertility? |
primary varicoceles |
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What is another name for undescended testes? |
cryptorchidism |
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What are undescended testes? |
- failure of one or both testes to descend into the scrotum - testis originate from an elongated embryonic gonad in the retroperitoneum at the level of the fetal kidneys |
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Where are most undescended testes (cryptorchidsm) found? |
- in the inguinal canal (70-80%) - they increase the risk of testicular carcinoma (40-50%) |
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Testicular torsion will or will not cause an acute hydrocele. |
will not |
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What are seminal vesicles? |
- reservoir for sperm - located posterior to the urinary bladder |
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What does varicocele look like? |
- extratesticular mass located posterior and superior to the testis - consists of dilated, tortuous, anechoic, tubular structures of uniform size - color flow will show increased signal during Valsalva maneuver - 5-6mm normal veins; less than 2mm in diameter |
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What is epididymitis? |
- inflammation of the epididymis - most common cause of intra-scrotal infection and acute scrotal pain and tenderness |
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What does epididymitis look like? |
- epididymis is enlarged and has variable echogenicity - enlarged epididymal head - increased color flow suggests infection |
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What does uncomplicated acute epididymitis look like? |
- uniformly enlarged - more hypoechoic than usual |
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What is the scrotum? |
- a sac of skin continuous with the abdomen
the following is contained in the scrotum: - testicles - epididymis - vas deferens - spermatic cord |
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What is the anatomy of the scrotum? |
- divided into two compartments which are divided by the medium raphe - the sac is lined by parietal layer of tunica vaginalis - the testicles are surrounded by the visceral layer of the tunica vaginalis |
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What are the normal measurements? |
the testicles are paired reproductive organs that measure approximately: - 3-5cm in length - 3cm a/p - 2-3cm width |
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What is the epididymis? |
- lies along the posterolateral aspect of the testicle - overall size is 6-7cm - epididymis head (AKA globulus major) is located at the superior aspect of the testicle |
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What is the anatomy of its blood supply? |
testicular artery: - originates below the renal artery directly from the aorta
veins: - the blood is drained through the pampiniform plexus, which contains veins that drain the testis and become the spermatic (testicular) veins |
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Where does the right spermatic (testicular) vein drain? |
direcly into the IVC |
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Where does the left spermatic (testicular) vein drain? |
into the left renal vein |
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What is an epididymal cyst? |
- caused by the obstruction of the efferent ductules or aberrant ducts - they differ from spermatoceles in that they contain serous fluid, not nonviable sperm - occur all along the epididymis |
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What does an epididymas cyst look like? |
- anechoic mass in the epididymis with well-defined margins and posterior enhancement - compression and displacement of the ipsilateral testis may occur if the cyst is large |
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What is testicular torsion? |
- twisting of the spermatic cord upon itself that leads to obstruction of the blood vessels supplying the testis and epididymis - more common in young males with a peak incidence occurring at 13yrs old - pressure within the testicle begins to build because of arterial obstruction, which leads to testicular ischemia |
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What is the salvage rate of testicular torsion if surgery is performed within 5-6 hours? |
the salvage rate is 80-100% |
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What is the salvage rate of testicular torsion if surgery is performed within 6-12 hours? |
the salvage rate is 70% |
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What is the salvage rate of testicular torsion if surgery is delayed over 12 hours? |
the salvage rate is only 20% |
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What ages does testicular cancer occur more often in? |
occur in young men ages 20-40 |
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What are seminomas? |
- most common type of germ cell tumor comprising 40-50% of all cases - most likely neoplasm detected on ultrasound: solid, homogeneous mass |
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Where is testicular cancer located? |
intratesticle mass (usually solid) |
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What does testicular cancer look like? |
- large with poorly defined borders and marked attenuation of sound secondary to their solid nature - reactive hydrocele - mass IN the testicle is considered malignant until proven otherwise |
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What does cancer look like within normal to enlarged testis? |
- focal and well-defined homogeneous hypoechoic region - diffuse and ill-defined region of decreased echogenicity - complex mass |
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There will be a question with subacute torsion, just remember: |
- to diagnose it, you have to use color flow Doppler the answer will be: decreased bloodflow |
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Explain sonographic appearance of testicular torsion. |
first 4 hours: appears normal 4-24 hours: - testis are enlarged and hypoechoic; contain areas representing hemorrhage - ultrasound may be normal 4-5 days: - testis markedly increase in size and decrease echogenicity - epididymis enlarged 10-30 days: - testis enlarged, irregular, more hypoechoic, heterogeneous - hydrocele may have resolved
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What are the 4 zones of the prostate (and their largement rate)? |
- peripheral zone: largest makes up about 70% of the glandular prostate - central zone: 20% - transition zone: 5% - periurethral glandular zone |
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What is benign prostatic hyperplasia (BPH)? |
- common in elderly men - patient presents with UTI, increased resistance and frequent urination |
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What does BPH look like? |
- homogeneous - symmetrically enlarged with a continuous border |
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What is the most common malignant tumor of the prostate? |
adenocarcinoma |
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Remember: |
- anything outside of the testicles, its fine - anything inside of the testicles is CANCER |
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What is serum prostatic specific antigen (PSA)? |
- used to evaluate the function of the prostate - PSA over 4.0 ng/ml is indicative of prostate disease |
