Ucsf: Video B 13 Part 4 Ultrasound Genitourinary (Scrotum-Extratesticular Mass)

Front 1

What is the ddx for a solid extratesticular solid mass
3

Back 1

adenomatoid tumor
sperm cell granuloma
subclinical chronic infection

Front 2

What is the ddx for a cystic extratesticular mass
2

Back 2

spermatocele
epidimymal cyst

Front 3

What is the only extratesticular mass that may have calcification

Back 3

TB epididymitis

Front 4

Are adenomatoid tumors common?

Back 4

no

Front 5

What is a solid tumor in the epididymis likely to be

Back 5

an adenomatoid tumor

Front 6

What is the most common extratesticular neoplasm

Back 6

an adenomatoid tumor

Front 7

Where are adenomatoid tumors commonly located

Back 7

in the epididymis but may be in the spermatic cord or the tunica

Front 8

What is the US characteristics of an adenomatoid tumor

Back 8

round
homogenous
isoechoic (but may be variable)

Front 9

What is the cause of a sperm cell granuloma

Back 9

prior vasectomy

Front 10

Can a subclinical chronic infection look similar to a adenomatoid tumor

Back 10

yes

Front 11

What are cystic masses in the epididymis
2

Back 11

spermatocele
epididymal cyst

Front 12

Where are spermatoceles commonly located

Back 12

the head of the epididymis

Front 13

Can a spermatocele be septated

Back 13

yes

Front 14

Can spermatocele be large and displace the testicle

Back 14

yes this is often the case

Front 15

What are spermatoceles associated with

Back 15

tubular ectasia of the rete testes

Front 16

What mimics a spermatocele

Back 16

a hydrocele

Front 17

What is a clue to differentiate a spermatocele from a hydrocele

Back 17

look for tubular ectasia of the rete testes

Front 18

Besides looking at the for tubular ectasia what is another technique to determine if a cyst is a hydrocele or a spermatocele

Back 18

if there is a cine loop you will see moving echoes

Front 19

Can you differentiate an epididymal cyst and a small spermatocele

Back 19

no give ddx that it may be either

Front 20

What are the US of an epididymal cyst

Back 20

small, unilocular, anechoic anywhere in the epididymis

Front 21

If there is a cyst in the tail or body of the epididymus what is it

Back 21

epididymal cyst

Front 22

If there is calcifications involving the epididymus what is it

Back 22

TB epididymititis

Front 23

What is the US appearance of TB epididymitis

Back 23

asymmentric epididymal enlargement
coarse calcifications

Front 24

What other cystic structure is often associated with TB epididymitis

Back 24

hydrocele

Front 25

What is the demographics that may present with TB epididymitis
2

Back 25

HIV,
from developing countries

Front 26

What is the ddx for solid mass of the tunica albugenia

Back 26

only 1 and it is adenomatoid tumor

Front 27

What is the ddx of a cystic lesion of the tunical albuginea

Back 27

only 1 and it is tunical cyst (very rare)

Front 28

Are tunical cyst benign

Back 28

yes

Front 29

What is the size of a tunical cyst

Back 29

small < 1cm

Front 30

What are the causes of calcification of the tunica albuginea
4 (non-specific)

Back 30

plaque
post traumatic
post inflammatory
post infectious
idiopathic

Front 31

Do we worry about any pathology arising from the tunica

Back 31

no

Front 32

What are two locations that an adenomatoid mass can arise from

Back 32

the epididymus
tunical albuginea (more hyperechoic)

Front 33

What is the size of normal veins in the pampiniform plexus

Back 33

1-2mm

Front 34

What measurment is needed for diagnosis of a varicocele

Back 34

more than 2 veins greater than 3mm

Front 35

What is the cause of a primary varicocele

Back 35

incompentent valves

Front 36

What percent of varicocels are on the left

Back 36

85

Front 37

What is the cause of a secondary varicocele

Back 37

retroperitoneal mass

Front 38

What are retroperitoneal masses that may cause a varicocele
3

Back 38

neoplasm
LN
hydronephrosis

Front 39

Is it worrisome if a lone varicocele is seen on the right

Back 39

yes

Front 40

What is the ddx for a solid mass of the tunica vaginalis
2

Back 40

inguinal hernia
spermatic cord neoplasm

Front 41

What is the ddx for a cystic mass of the tunica vaginalis
4

Back 41

hydrocele
lymphocele
hematocele
pyocele

Front 42

If you see a cyst mass of the tunica vaginalis is it always a hydrocele

Back 42

no, can be a lymphocele, hematocele or a pyocele

Front 43

When saying with in the tunica vaginalis what is that the same as

Back 43

inside the scrotal cavity

Front 44

What is you see a mass with in the scrotal canal (inside of the tunica vaginalis) and it has a lot of echogenicity

Back 44

it is probably a fat containing inguinal hernia

Front 45

What does an inguinal hernia look look on US

Back 45

mass with a lot of echogenicity with in the scrotal cavity

Front 46

How do you confirm if something is a inguinal hernia

Back 46

if it peristalsis or follow up into the inguinal canal

Front 47

What is the ddx for a benign spermatic cord neoplasm
3

Back 47

benign-- lipoma, lipomatosis, adenomatoid

Front 48

What is the ddx for a malignant spermatic cord neoplasm
2

Back 48

sarcoma, mesothelioma

Front 49

What should you order if you are not sure if a mass in the scrotal cavity is an inguinal hernia

Back 49

an MRI

Front 50

What is the MC cystic lesion in the scrotal cavity

Back 50

a hydrocele

Front 51

How do you diffferntiate a hydrocele from a lymphocele, hematocele, pyocele

Back 51

the lymphocele, hematocele and pyocele will have internal echos

Front 52

What does a hydrocele look like on US

Back 52

fluid all the way around the testicle can be seen except in the area that is tact down by the gubernaculum

Front 53

What is the main ddx for a scrotal cystic mass

Back 53

spermatocele

Front 54

What is a scrotal pearl

Back 54

autoamputation of a torsed appendix testis or appendix epididymis or a conglomeration of free floating crystalline debree floating in a hydrocele from a prior infection

Front 55

What is a scrotal pearl associated with

Back 55

hydrocele

Front 56

What is a mass that has calcification within the scrotal cavity

Back 56

scrotal pearl

Front 57

What is the us characteristics of a scrotal pearl

Back 57

free floating, coarse calcification, associated hydrocele

Front 58

What causes scrotal cavity calcification in an infant

Back 58

meconium periorchitis

Front 59

How does meconium periorchitis occur

Back 59

secondary to meconium peritonitis and a patent processus vaginalis

Front 60

What are two complication of a patent processus vaginalis

Back 60

hernia and hydrocele

Front 61

What does a meconium periorchitis look like on US

Back 61

scattered coarse calcium surrounding the testes

Front 62

What is the ddx for acute testicular pain

Back 62

infection or torsion of the testicle

Front 63

What type of infection typically occurs in a post pubertal man
2

Back 63

epididymitis
epididymo-orchitis

Front 64

What percent of pt epididymitis will also have an orchitis

Back 64

20%

Front 65

What is the mechanism of infection

Back 65

ascending and therefore will affect the tail of the epididymis and work its way to the testicle

Front 66

What are the causes of isolated orchitis
4

Back 66

ishemia
mumps
symphilis
TB

Front 67

What is seen in epididymitis on US

Back 67

a large hetergeneous/hypoechoic epididymus with increased flow

Front 68

Is it possible that increased flow is the only sign of epididymitis

Back 68

yes

Front 69

What happens to the testicle when it is infected

Back 69

it will become edematous

Front 70

What normally has more flow the testicle or the epididymis

Back 70

the testicle, therefore if the epididymis has increase flow or the same as the testicle this may be the result of infection

Front 71

What are the findings of epididymo-orchitis

Back 71

heterogenous/hypoehechoic epididymis with increased flow

teste enlarged, heterogeneous parenchyma with scrotal wall thickening, pyocele, abscess

Front 72

What are 2 findings that may be adjacent to a testicle in epididymo-orchititis

Back 72

scrotal wall thickening
pyocele

Front 73

If you see a complex mass where the testicle in the setting of severe scrotal pain what should be suspected

Back 73

an abscess from epididymo-orchitis

Front 74

What is fournier gangrene

Back 74

this is advanced epididymo-orchitis and is fulminant gangrene of the scrotal wall

Front 75

What is an indication that fourniers gangrene might be occuring

Back 75

marked scrotal wall thickening
scattered echogeinic foci (gas)

Front 76

What age group has the highest rate of torsion

Back 76

adolescents

Front 77

What predisposes a pt to a testicular torsion

Back 77

bell clapper deformity (not tacked down by the gubernaculum)

Front 78

What is considered the time limit for a viable testicle

Back 78

less than 4 h

Front 79

What is occluded first in the testicle torsion the veins or the arteries

Back 79

the veins

Front 80

Is edema associated with testicular torsion

Back 80

yes

Front 81

What is the best way to analyze a patient with suspected testicular torsion

Back 81

compare sides

Front 82

What are 3 characteristics on US that will indicate one of the testicles is torsed when comparing

Back 82

the torsed side will be enlarged hypoechoic, and have decreased flow

Front 83

Can a torsed testicle have flow

Back 83

yes

Front 84

What does it mean if there is increased flow to an enlarged testicle

Back 84

the testicle may have detorsed

Front 85

What are associated findings in a patient with torsion
3

Back 85

epididymal enlargment
scrotal wall thickening
hydrocele

Front 86

Can it be difficult to differntiate testicular torsion from epididymo-orchitis

Back 86

yes, both can have enlarge testicle and epididymis, scrotal wall thickening

Front 87

What is the best way to differentiate testicular torsion from epididymo-orchitis

Back 87

flow. increased in infection and decreased with torsion

Front 88

Can the testicle ruputure with trauma

Back 88

yes

Front 89

What happens during rupture of the testicles

Back 89

the semiferous tubules come out

Front 90

Why is it important to dx a ruptured testicle early

Back 90

if the semiferous tubules are put back and it is repaired there is a dramatic decrease in orchiectomy

Front 91

What may be seen in the setting of trauma to the testicle
3

Back 91

hematoma
hematocele
rupture

Front 92

What are 3 types of hematomas that may occur to the scrotum

Back 92

intratesticular
subcapsular
scrotal wall

Front 93

How do you recognize a ruptured testicle on US

Back 93

follow the tunica and look for an interuption

Front 94

What are the 4 portions of the testicle in which pathology can occur extratesticularly

Back 94

epididymal
tunical
venous
scrotal

Front 95

With in each what are the main categories of pathology

Back 95

solid, cystic, calcification

Front 96

what are the 2 intratesticular categories of pathology

Back 96

diffuse
focal

Front 97

With in each what are the main categories of pathology

Back 97

solid, cystic, calcification

Front 98

If there is a solid mass intratesticular mass and it is bilateral what is the ddx

Back 98

lymphoma, adrenal rest, sarcoid

Front 99

If there is a solid intratesticular mass and it is unilateral and there is increased flow what is it

Back 99

neoplasm or infection

Front 100

If there is a solid intratesticular mass and it is unilateral and there is decreased flow what is it

Back 100

infarct or hematoma

Front 101

If there is a solid intratesticular mass and it is unilateral and there is increased flow tthat involves the epididymis what is the cause

Back 101

infection

Front 102

If there is a solid intratesticular mass and it is unilateral and there is increased flow and it doesnt involve the epididymis what is it

Back 102

neoplasm