scrotal pathology

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scrotal __ presents a challenge to the tech because the scrotum is often painful and swollen; may be a result of a motor vehicle accident, athletic injury, direct blow to the scrotum, or a straddle injury; the most important goal of this is to determine i: trauma
rupture of the testis is a surgical emergency requiring a prompt dx; if surgery is performed within __ hours after the injury, up to 90% of testes can be saved, but only 45% can be saved after this deadline: 72 hours
__ and __ are both complications of trauma; however, neither is specific to trauma: hematocele and hydrocele
contain blood and are also found in advanced cases of epididymitis and orchitis; result from bleeding of the pampiniformis plexus or other extratesticular structure; doesn't confirm rupture: hematocele
sono appears as focal alteration of the testicular parenchymal pattern, interruption of the tunica albuginea, irregular testicular contour, scrotal wall thickening, and hematocele; associated with abscess, tumor, or other clinical condition. when combine: hematocele/ hydrocele rupture?
hematoceles vary with __.: age
acute hematocele is __ with numerous highly visible echoes that can be seen to float or move in __. with time it shows low-level echoes and develops __: echogenic, real-time, septations
__ in testicular trauma include identification of blood flow disruption across the surface of the testis which is an indication of rupture and can aid inseparating a normally vascularized testis from one that is disrupted by hematoma: color doppler
may result from trauma and color doppler imaging can be used to identify the associated increased vascularity in the epididymis: epididymitis
tortion may also be associated with __ and color doppler is used to confirm an absence of flow int he testis with torsion.: trauma
___ associated with trauma may be large and cause displacement of the testis. appear as heterogeneous within the scrotum. they tend to become more complex with time, developing cystic components; may involve the testis or epididymis, or they can be cont: hematomas
inflammation of the epididgymis 1st which spread to the testes; is most commonly resulting from the spread of a lower urinary tract infection via the spermatic cord; less common causes include mumps, syphillis, tb, viruses, trauma, or chemical causes; rep: epididymo-orchitis
represents teh most common cause of acute scrotal pain in adults: epididymo-orchitis
the epididymis is the organ primarily involved with infection, spreading to the testis in about __ to __ % of cases: 20-40%
__ almost always occurs secondary to epididymitis: orchitis
patients typically present with increasing scrotal pain over 1 to 2 days; the pain may be mild or severe; symptoms may include fever, elevated wbc, and urethral discharge: epididymo-orchitis
sono appears as an enlarged, hypoechoic gland; enlargement of epididymis; if secondary hemorrhage has occured, the epididymis may contain focal hyperechoic areas; hyperemic flow is confirmed by color doppler; the normal epididymis shows little flow but th: epididymo-orchitis
sono appearance of epididymo-orchitis: if the infection is isolated to the epididymis, the testis appears normal; when orchitis has developed, ultrasound imaging shows and enlarged __; the infection may be focal or diffuse, with the affected areas appeari: testes, heterogenous, homogenous, 20%
sono appearance of epididymo-orchitis con't: __ flow with significantly more visible vessels on color doppler are seen compared with the asymptomatic side; is seen in the epididymis and testis when both are involved, but isolated to the epididymis if the: hyperemic
other sono findings associated include scrotal wall thickening and hydrocele; hydroceles are found around the anterolateral aspect of the testis; they may appear anechoic or contain low-level echoes; complex hydroceles may be associated with severe versio: epididymo-orchitis
in severe cases of epididymo-orchitis a __ may be present;occurs when pus fills the space between the layers of the tunica vaginalis; it usually contains internal septations, loculations, and debris; this same appearance can occur after trauma or surgery.: pyocele
a swollen testis is confined within a rigid __. excessive swelling can cause obstruction tot eh testicular blood supply. color doppler shows decreased or absent flow compared with teh contralateral testis; with decreased flow, doppler has high resistanc: tunica albuginea
a doppler waveform demonstrating reversed diastolic flow is a serious finding indiating threatened testicular __ which can affect the entire testes or be confined to a focal area: infarction
with focal infarction, color show __ inonly portions of the testis with an absence of color signals in the affected areas. in diffuse the testis appear __ compared with the surrounding testicular parenchyma depicting a heterogenous pattern: perfusion, hypoechoic
occurs as a result of abnormal mobility of the tests within the scrotump an anomaly termed bell clapper deformity is the most common etiology of this condition which affects the bare area: torsion
this anomaly occurs when the tunica vaginalis completely surround the testis, epididymis, and distal spermatic cord, allowing them to move and rotate freely within the scrotum; normally the testis and epididymis are surrounded by the tunica vaginalis, exc: torsion
results when teh testis and epididymis twist within the scrotum, cutting off the vascular supply within the spermatic cord; undescended testes are 10 times more likely to be affected than normal; compromised blood flow to the testis, epididymis, intrascro: torsion
backup of venous system; venous flow is affected first with the occluded veins, causing swelling of the scrotal structures on the affected side; if it continues, the arterial flow is also obstructed and testicular ischemia follows: torsion
torsion of the __ is a surgical emergency; salvage rate of the testis depends on the elapsed time since torsion. if surgery is performed within __ to __ hours of the onset of pain then 80-100% of testes can be saved. between __ and __ hours the salvage: spermatic cord, 5-6 hours, 6-12 hours, 12 hours
most common cause of acute scrotal pain in adolescents; although it is more common in yound adults and adolescents, it can occur at any age with the peak incidence at 14: torsion
patient presents with a sudden onset of scrotal pain accompanied by swelling on the affected side; the severe pain causes nausea and vomiting in many patients; patients frequently report previous episodes of scrotal pain: torsion
sono appearance depends on how much time has elapsed; in early stages, the scrotum may appear normal. after 4-6 hours the testis become swollen and hypoechoic and very large. the lobes within the testis usually are well identified during this time becau: torsion
after 24 hours, the testis become heterogenous because of hemorrhage, infarction, necrosis, and vascular congestion; the epididymal head appears enlarged and has decreased echogenicity or becomes heterogenous; dx by absence of color flow; make sure you de: torsion
sono appearance cont: ins ome cases the twisted spermatic cord knot may be seen as a round or oval extratesticular mass that can be traced back to the normal portion; other findings may include scrotal skin thickening and reactive hydrocele; color dopple: torsion
appearance depends on how long the testis was torsed and how long it has been since relief, the intratesticular flow may be minimal or hyperemic; extratesticular flow is usually increased: detorsion
torsion of the __ of the epididymis or testis can also occur and further complicates the clinical picture; the clinical presentation is similar to that of testicular torsion and epididymo-orchitis; ultrasound may show a small, hypoehoic mass located betwe: appendix
are benign fluid collections that may be located within the testis or in extratesticular structures; most are extratesticular and are found in the tunica albuginea or epididymis: cysts
common; are cystic dilations of the efferent ductules of the epididymis; they are always located in the epididymal head; contain proteinaceous fluid and spermatozoa (sperm); may be see more often after vasectomy: spermatocele
are small, clear cysts containing serous fluid; theycan be found anywhere in the epididymis but mainlyin body and tail; sometimes small cysts are found between the layers of the tuniva vaginalis or between the tunica vaginalis and tunica albuginea: epididymal cyst
are a subcapsular abnormality, whichmay be embryologic, traumtaic, or post-infectious; they occur in the upper lateral aspect of teh testicle and are very firm; most common among men 40-60 years; palpable mass: tunica albuginea cyst
all three are generally asymptomatic, although they may be palpable and cause concern to the patient: spermatocele, epididymal cyst, tunica albuginea cyst
sonographically, ultrasound can't reliably differential between __ and __ other than location. __ may be seen simple cysts or multilocular cystic collections containing internal echoes in head of epididymis. __ appear as simple fluid-filled structures h: *spermatoceles and epididymal cysts *spermatocele *epididymal cysts *tunica albuginea cysts *2-5 mm
abnormal dilation of the veins of the pampiniform plexus (venous system); usually are caused by incompetent venous valves within the spermatic vein; occur more on the left side: primary varicocele
idiopathic but related to left renal vein and left spermatic vein drainage; the spermatic vein empties into the LRV at a steep angle, which may inhibit blood flow return; the lrv can become compressed between the ao and sma: primary varicocele
caused by increased pressure on the spermatic vein usually caused by a retroperitoneal mass; this may be the result of hydronephrosis, ab mass, or liver cirrhosis; an ab malignancy invading the lrv may cause a varicocele with non-compressible veins; usual: secondary varicocele
any non-compressible varicocele in a man greater than 40 should prompt a search for a __: retroperitoneal mass
have a relationship with imparied fertility; they are more common in infertile men; most common correctable cause of male infertility; treatment has been shown to improve sperm countin up to 53% of patients: varicocele
uncommonly these may extend within the testis near the mediastinum; intratesticular ones have an unknown clinical significance, but it is possible thay they affect male fetility by the same mechanism as the extratesticular kind: varicocele (intratesticular varicocele)
sono appearance: look lateral to testis; shows numerous tortuous tubes of varying sizes within the spermatic cord near the epididymal head; the tubes may contain echoes that move with real-time imaging which represent slow venous flow; measure greater tha: varicocele
scanning with the patient in upright position enhances the visibility of a __ because the veins become more distended; however, supine scanning with valsalva and color doppler is adequate. with either protocol color and spectral doppler are used to confi: varicocele
sono appears as straight or serpiginous channels coursing from the mediastinum into the testicular tissue; color and spectral doppler are used to identify these channels as dilated veins; on grayscale imaging, the appearance may mimic that of tubular ect: intratesticular varicocele
occurs when the small bowel or omentum pushes its way through the hole that the testicles pass thourgh to reach the scrotum during a baby's development; patient presetn with a large, painless lump in the scrotum: scrotal hernia
sono appears as peristalsis of bowel may be seen; fluid-filled bowel loops are easily recognizable by ultraosound; air-filled loops or loops containing solid stool are more difficult to recognize; on ultrsound, air appears as bright echoes with a dirty ac: scrotal hernia
closely assoc. with vasectomy; occur as a chronic inflammatory reaction to extravasation of spermatozoa; may be located anywhere within the epididymis or vas deferens. a collection of fluid that leaks from an improperly sealed or tied vas deferens; they u: sperm granuloma
ultrasound imaging is used to determine if the mass is intratesticular or extratesticular; __ masses have a much lower rate of malignancy: extratesticular
patients present with pain and with a clinical history of vasectomy; sono appears as a well-defined, solid mass thay may appear hypoechoic or isoechoic to the epididymis; they are often heterogeneous; calcifications are not commonly present; they may show: sperm granuloma
a potential space exists between the visceral and parietal layers of the tunica vaginalis; normally a small amount of fluid is present in this cavity and should not be confused with the presence of a ___: hydrocele
contains serous fluid and is the most common cause of painless scrotal swelling; may have an unknown cause but are commonly assoc. with epididymo-orchitis and torsion; they also may be found in patients after trauma or a neoplasm; assoc with neoplasms ten: hydrocele
collections of pus; they occur with untreated infection or when an abscess ruptures into the space between the layers of the tunica vaginalis; have fever and elevated wbc; much less common than hydroceles: pyoceles
are assoc. with trauma, surgery, neoplasms, or torsion; they are collections of blood and are much less common than hydroceles: hematoceles
hydroceles, pyoceles, and hematoceles occur in the __ portion. you can only distinguish between pyocele and hematocele by __ because they mimic each other: anterolateral, clinical symptoms
sono appears as anechoic but most often contain some low-level echoes resulting from cellular debris; doesn't contain loculations; ones asso. with infection show more internal echoes and septations: hydroceles
sono appears as internal echoes, thickened septations, and loculations;: pyocele and hematocele
ultrasound depiction of air within the space indicates an abscess, although an abscess may occur without presence of ___: air
an uncommon, benign condition; it is associated withthe presence of a spermatocele, epididymal or testicular cyst, or other spididymal obstructionon teh same side as the dilated tubules; buildup of sperm; it is more commonly seen in patients 45 years or o: tubular ectasia of the rete testis
sono appears as prominent hypoechoic channels near the echogenic mediastinum testis; color doppler can confirm the avascular nature; may mimic intratesticular varicocele but won't have color on dopper; due to obstruction or trauma: tubular ectasia of the rete testis
are more ocmmon in men over 40 years of age and have an assoc with extratesticular spermatoceles; they are located near the mediastinum; they may be single or multiple and of variable size; are incidental finding on sono and don't require treatment: intratesticular cysts
sono appears anechoic with posterior acoustic enhancement and a smooth border; varies from 2-28 mm; characteristics of simple cyst: intratesticular cyst
be careful because malignancies can have __ components: cystic
this is an uncommon condition characterized by tiny calcifications within the testis; calcifications along border of seminiferous tubules; these microcalcifications are smaller than 3 mm; is usually bilateral; has been reported to have an association iwth: microlithiasis
been associated with cryporchidism, klinefelter's syndrome, infertility, varicoceles, testicular atrophy, and male pseudohermaphroditism: microlithiasis
sono appear as multiple, birght, non-shadowing foci are seen scattered through the testis; may be quite numerous, but are not considered to be abnormal unless more than 5 appear on any single image: microlithiasis
seen between layers of tunica vaginalis; extratesticular scrotal calculi that arise from the surface of the tunica vaginalis; may break loose to migrate between teh two layers; may result from an inflammation of the tunica vaginalis or a torsion of the ap: scrotal pearl
calcifications that shadow; seen as a mobile scrotal calcification and reactive hydrocele may be seen: scrotal pearl
two types of testicular tumors: germ-cell and non-germ-cell
testicular cancer is not comm0on, comprising onlyu __% of cancers in men, but it is the most comm0on malignancy in men between the ages of __ and __. fortunately, testicular cancer is one of the most curable forms of cancer; it is more common in __ male: 1%, 15-35, white, 20-34
undescended testes are __ to __ times more likely to develop cancer: 2.5-8
most patients have no other symptoms except a painless lump, testicular enlargement, or vague discomfort in the scrotum; the primary goal of teh ultrasound exam in testicular tumors is to determine mass location and differentiate between cystic and solid: malignant, benign
intratesticular cysts are benign masses, but care must be taken to ensure a cyst is ___ because some testicular cancers contain cystic components; some benign conditions may mimic malignancy; these include hematome, orchitis (especially when focal), absce: simple
__ can't differentiate between benign or malignant because testicles are so vascular so want to determine characteristics (cystic vs. solid) and intra vs. extratesticular: color
testicular cancers cause an increase in __ and __ levels: AFP and hCG
tumor of all 3 germ layers; are associated with an elevated level of hcg and afp; approx 95% of all testicular tumors this type and are very malignant: germ-cell tumors
the most common type of germ-cell tumor is __ followed by mixed __ and __: seminoma, mixed embryonal cell tumors, teratocarcinomas
other less common germ cell tumors include 4:: yolk sac, choriocarcinoma, teratomas, combos of these
sono ultrasound is nearly __ % sensitive for detecting tumors: 100
most tumors appear as __, __ masses; ultrasound imaging can't differentiate malignant from benign masses; beither color doppler nor doppler waveforms can reliably distinguish between flow patterns of benign and malignant tumors: focal, hypoechoic
rarest type of germ cell tumor, accounting for less than .5% of malignancy; peak incidence is in the second and third decades; highly malignant and metastasize early by hematogeneous and lymphatic route: choriocarcinoma
patient presents with gynecomastia, elevated hcg levels: choriocarcinoma
sono appears as having a varied sonographic appearance because of mixed cell types; their appearance is determined by the dominant cell type, but they typically have irregular borders, calcification, and focal areas of necrosis: choriocarcinoma
a little aggressive; rare tumor accounting for only 2-3% of germ cell tumors; peak incidence of the latter part of the second and third decade: embryonal cell carcinoma
sono appears heterogeneous and less well circumscribed; they may contain areas of incresed echogenicity resulting from calcification, hemorrhage, or fibrosis; cystic components are found in up to one third of them;: embryonal cell carcinoma
more aggressive than seminoma, often invading the tunica albuginea and distorting the testicular contour; not smooth walls: embryonal cell carcinoma
most common germ cell tumor in infants younger than two year; associated with elevated afp in 95% of infants; 1/3 can have cystic components. sonographically looks like embryonic cell tumor: yolk sac tumor
constitute approx 5-10% of primary testicular neoplasm; 1/3 metastasize, usually by lymphatic route, within 5 years; peak incidence is in infants/early childhood (immature) and then another peak in third decade (mature): teratoma
patient presents with elevated afp and hcg; in infants and children, it's the most common testicular tumor and most commonly benign; in adults it's typically malignant: teratoma
sono it may show dense foci that produce acoustic shadowing; they are normally heterogeneous but have well-defined border: teratoma
most common single-cell type of testicular tumor in adults; occur in slightly older patient with a peak incidence of fourth and fifth decades; rarely occur before puberty; less aggressive than other testiuclar tumors and responds well to treatment: seminoma
most common tumor associated with cryptochidism tumor arises in puberty: seminoma
sono they tend to be homogenous, hypoechoic masses with a smooth border; is uniform and has low level echoes without calcification or cystic components; if large tend to be heterogeneous with foci of necrosis and hemorrhage; usually unilateral and testis: seminoma
is rare normally occuring later in life >60 yrs; bilateral with multiple lesions found; sono appears as a solid hypoechoic mass, although it has been reported as hyperechoic or a mixture of both: mets
mets may originate to the testis via these 8: prostate and kidneys (most common), lung, pancreas, bladder, colon, thyroid, melanoma
most common secondary tumor of testicles; makes up 1-7% of all testicular tumors and is the most common bilaterly secondary testicular neoplasm affecting men greater than 60 years old 60-70): non-hodgkins lymphoma
___ involvement of the testicle is the next most common secondary testicular neoplasm most often found in children with 8% of children having this disease having testicular involvement: leukemia
patients present with weight loss, anorexia, and weakness; the testicle may become enlarged and the tumor may be bilateral or unilateral: lymphoma/leukemia
sono testes may appear homogenously hypoechoic, or contain multiple focal areas of decreased echogenicity: lymphoma/leukemia
__ may appear as a focal, well-circumscribed, anechoic mass with through transmision; increased vascularity is seen with color doppler imaging: chronic lymphocyte leukemia
means undescended testes and can't be brought into the scrotum with external manipulation: cryptorchidism
during fetal growth, the testes first appear in the __ near the kidneys; they descen into the scrotum from the inguinal canal shortly before birthor early in the neonatal period: retroperitoneum
may be located in the ab, inguinal canl, or other ectopic location such as top area of scrotum; in most cases (80%) they are in inguinal canal and is usually palpable: cryptorchidism
since the testes don't descend until late in pregnancy, cryptorchidism is more common in ___. is bilateral in __ to __% of cases; surgical treatment of an undescended testicle by freeing it from the structures and implanting it into the scrotum is known: premature babies, 10-25%, orchiopexy
the exposure of the testis to higher temp than when it is located in the scrotum can prohibit spermatogenesis and result in __. also have an increased risk of developing __ which is not reduced by orchiopexy, but it does allow the testis to be more easil: infertility; testicular cancer
__ is also more common with undescended testes: torsion
sono the y appear smaller and less echogenic than normal testis; itis usually oval with a homogenous texture; rarely the mediastinum is seen: cryptorchidism
very rare condition; unlike an undescended testicle, this cannot be manipulated into the correct path of descent: testicular ectopia
the most common site for testicular ectopia is ___: superficial inguinal pouch (other sites are perineum, femoral canal, suprapubic area, penis, diaphragm, and the other scrotal compartment)
a rare condition; causes include intrauterine testicular torsion or other forms of decreased vascular supply to the testicle in utero; bilat. is found in 0.6%-1% of patients with nonpalpable testis; patient have male xy genotype; on physical exam, the scr: anorchia
found in 4% of patients with a nonpalpable mass; more common on left side, and definitive dx depends on surgical dx: unilateral anorchia (monorchia)
nonfunctioning; is a very rare disorder, with only 80 cases reported; if descend before the real one then you will have cryptorchidism; testicular duplication which is usually found in the scrotum, but also has been found in the inguinal canal or rp; is u: polyorchidism (testicular duplication)

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