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100
What is the ideal imaging modality for evaluation of the acute scrotum in adults and children?
Ultrasound
100
The epididymis is ___________ to the testicle
parallel
100
AKA Vas deferens
Ductus Deferens
100
The testes migrate through the _________________ into the scrotal sac.
inguinal canal
100
AKA for head of the epididymis
Globus major
100
AKA Cremasteric artery
External Spermatic Artery
100
AKA tail of Epididymis
Globus minor
100
AKA Testicular Artery
Internal Spermatic Artery
100
AKA for calcifications
Scrotal Pearls
100
AKA yolk sac tumors
Endodermal sinus tumors
200
Form wedge-shaped compartments that contain the _________________
Septa; seminiferous tubules
200
Pediatric testes are _______________ and measure ~ _______ with uniform low-to-medium echogenicity.
ovoid; 1 cm
200
Attention to appropriate color Doppler settings is needed because detection of ________________ is critical
Slow flow
200
Thick fibrous connective tissue capsule that surrounds the testicle
tunica albuginea
200
From age 8 to puberty the testes are about ___________
4 cm
200
What kind of echotexture does a normal testis have?
Homogeneous medium level echo texture
200
Forms the support for the entering and exiting testicular vessels and ducts
Mediastinum
200
The thin hypoechoic ring of fibrous tissue surrounding the testis giving it an encapsulated appearance
Tunica Vaginalis
200
This is where sperm become concentrated and other fluids are reabsorbed
Rete testis
200
Largest part of Epididymis
Head
300
What two things should be performed when evaluating for varicoceles?
1. Valsalva
2. scanning in upright position
300
What are the 2 layers of the tunica vaginalis?
1. Visceral (touching organ)
2. Parietal (not touching organ)
300
Which layer of the tunica vaginalis lines the scrotal chamber?
Outer (Parietal)
300
The epididymis is where the _________________ converge to form a single convoluted duct called the _______________
efferent ductules; ductus epididymis
300
_________________ is a useful adjunct to color Doppler in low flow states, but it is more sensitive to _______________
Power Doppler; motion artifacts
300
Carry the seminal fluid from the rete testis to the epididymis
efferent ductules
300
As the tail of the epididymis courses cephalad it becomes known as the ________________
vas deferens
300
Supports the testes in the scrotal sac and has a thin film of serous fluid between its layers
Tunica vaginalis
300
Primary function of the spermatic cord
facilitate passage for semen through the vas deferens
300
Attached to the posterior wall of the testis preventing each testis from rotation within the scrotum
Tunica Vaginalis
400
The seminiferous tubules course centrally to form these 20-30 larger ducts
Tubuli recti
400
Normal measurements of the Epididymis:
__________ Head
__________ Tail
__________ Body
Head 5-12 mm
Tail 2-5 mm
Body 2-4 mm
400
The division of the 2 scrotal chambers
Scrotal Raphe
400
Runs through the abdominal region down to the testicles
Spermatic cord
400
Venous drainage of the scrotum occurs through the veins of this
Pampiniform Plexus
400
The tunica albuginea is continuous posteriorly and divides the testis into _____________
~ 250 lobules
400
The right testicular vein drains into this
IVC
400
The adult testes are _________ and roughly:
______ length
______ width
______ AP
Ovoid; 3-5 cm length; 2-4 cm width; 3 cm AP
400
Layer of smooth muscle fibers that live beneath the scrotal skin and divides the scrotum into 2 chambers
Dartos muscle
400
500
The left testicular vein drains into this
Left Renal Vein
500
Where does the pampiniform plexus terminate?
into the testicular vein
500
Intrascrotal masses can be detected with a sensitivity of _____
nearly 100%
500
Well defined anechoic lesion located near the mediatinum and most likely originate from the rete testis
Testicular cyst
500
The deferential vein drains into this
Pelvic veins
500
Manual detorsion involves rotating the painful testicle outward like this
opening a book
500
Normal scrotal skin measures __________ in thickness
2-8 mm
500
Sign for Varicocele
"Bag of Worms"
500
The Cremasteric vein drains into this
Tributaries of the epigastric veins
500
600
Usually a complication of epididymo-orchitis; present with enlarged testicle containing a fluid-filled mass with hypoechoic or mixed echogenic areas
Abscess
600
Over half of the testicular ruptures occur during what
sporting events
600
The second most cause of testicular rupture is
MVA
600
An initial infarct looks like what?
focal or diffuse hypoechoic testicle
600
Occurs in 15 to 40 percent of men who undergo vasectomy
sperm granuloma
600
Benign cysts that are well circumscribed and of germ cell origin; mostly 20s and 40s; painless testicular nodule filled with flaky, cheesy, white keratin
Epidermoid cysts
600
After a longer time a testicular infarct looks like this
Testicle decreases in size and areas of increased echogenicity (fibrosis and calcs)
600
One of the most common genitourinary anomalies in male infants
cyryptorchidism
600
Where do the testicles form?
near the kidneys
600
Increased blood flow
hyperemia
700
Approximately 90% of rupture testicles can be saved if surgery is performed within the first _________ hours
72
700
Epididymal cysts are found where in the epididymis
head
700
40 year old male, asymptomatic, palpable mass on testicle seen on the periphery of the testicle
tunica albuginea cyst
700
cyst that is more common than epidydimal cysts
Spermatocele
700
Microlithiasis may be associated with this
Testicular cancer or mass
700
This is seen as an enlarged and hypoechoic testicle with increased blood flow
orchitis
700
Undescended testicle or hidden testicle
Chryptorchidism
700
May be seen within the parenchyma of the testicle, on the surface, or freely located within hydrocele; testicular microlithiasis could be seen with this
Scrotal Pearls
700
Epididymal cysts are caused by this
prior case of epididymis
700
mass that develops as a result of the body's immune reaction to sperm leaking from the cut of end of the vas
Sperm Granuloma
800
Most common extratesticular tumor
Benign adenomatoid tumor
800
Most common cause of painless scrotal swelling
hydrocele
800
Typically, the testicle is attached to the tunica vaginalis; without this attachment or a higher attachment than normal, the testicle can rotate freely on the spermatic cord, which is called this
Bell Clapper Deformity
800
Rare and usually involve the epididymis; commonly in 20-50 year old pts; generally unilateral, solitary and well defined rarely over 5 cm
extratesticular tumors
800
Abnormal collection of serous fluid between the layers of the tunica vaginalis
Hydrocele
800
Most malignant testicular neoplasms appear
Hypoechoic compared to rest of testicle
800
Most common extratesticular tumor in adults
adenomatoid tumor of the epididymis
800
Most common condition that causes acute scrotal pain
epididymitis
800
This requires immediate surgery
Torsion
800
Torsion most often involves the _________ testicle
left
900
Typically patients present with the insidious onset of pain, which increases over 1-2 days; fever, dysuria and urethral discharge may also be present
Epididymitis
900
Testicular salvage rate is 80-100% if surgery is performed within _________ hours of the onset of pain
5-6
900
A rare gonadal stromal tumor that presents with feminization with gynecomastia; small homogeneous and hypoechoic that are often bilateral
Sertoli
900
Collection of abnormally dilated, tortuous and elongated veins of the pampiniform plexus located posterior to the testis
Varicoceles
900
Leydig cell tumor produces ___________________ resulting in _______________
Progesterone; precocious puberty
900
What is this muscle and divider?
muscle: dartos
divider: scrotal raphe
900
caused by direct trauma to the testis or torsion leading to hemorrhagic suffusion or invasion by tumor
hematocele
900
Alpha fetoprotein and testicular tumor: suspect what type of cancer?
non-seminomatous tumor
900
Most common correctable cause of male infertility
varicoceles
900
Epidermoid cyst
1000
2 complications of cyrptocrchidism
1. infertility
2. cancer
1000
Epididymitis is usually caused by:
______________ men > 35
______________ men < 35
men > 35 trauma or UTI
men < 35 sexually transmitted diseases
1000
Most common malignant mass of the testicle
seminoma
1000
Most primary malignant tumor of testicle are of ____________ origin
germ cell
1000
Tunica Albuginea cysts
1000
2 types of Varicoceles
1. Primary or idiopathic
2. Secondary
1000
Most common secondary testicular neoplasm
Malignant lymphoma
1000
2 most common causes of acute scrotal pain
1. epididymitic/orchitis
2. torsion of the spermatic cord
1000
Half of bilateral testicular neoplasms are ______________
malignant lymphomas
1000
Sonographically associated with:
1. enlarged hypoechoic epididymis
2. hypoechoic testicle
3. increased blood flow compared to the asymptomatic side
4. reactive hydrocele
5. scrotal wall thickening
Epididymitis
1100
Most malignant testucular neoplasms are more _____________ than normal testicular parenchyma
hypoechoic
1100
Most malignant lymphomas of the testicle are this type
non-Hodgkin's type
1100
What results in failure of testicular descent predisposes the patient to malignancy?
Hormonal deficiency
1100
The yolk sac tumor is what kind of tumor?
Germ cell
1100
Seminomas spread initially where?
lymph nodes in retroperitoneum
1100
Fetal hydrocele has what sign?
Owl
1100
Least common and most lethal form of germ cell tumors
choriocarcinoma
1100
Most common prepubertal testicular tumor
Yolk sac tumor
1100
Second more common testicular tumor in children
teratoma
1200
What can be mistaken for the testis?
a Large Lymphnode
1200
Malignant lesions to the scrotal wall are usually of _____________ origin.
epididymal
1200
Malpositioned testes may be located anywhere along the pathway of descent from the ______________ to the ______________
retroperitoneum; scrotum
1200
Scrotal Pearls
1200
Cryptorchidism is not associated with this
Hydrocele
1200
This tumor is associated with an increase in beta hCG
Choriocarcinoma
1200
Patients with testicular neoplasms often present with these 2 things.
1. painless unilateral testicular masses
2. diffuse testicular enlargement
1200
The 2 most common metastatic testicular tumors
1. lymphoma
2. leukemia
1200
What tumor has an incerased level of alpha-fetoprotein?
Yolk sac tumor (germ cell)
1300
Teratomas in children are usually _______ and in adults are usually _________
benign; malignant
1300
Most common malignant paratesticular tumor in infants and children
rhabdomyosarcoma
1300
Microlithiasis
1300
Most common germ cell tumor in adults
Seminoma
1300
The majority of stromal tumors are
Leydig cell
1300
The highest risk factors for testicular cancer is being a _________________ and ______________________ between _____ and ______
White male
males
15
35
1300
___________________ metastasize by hematogenous routes
Choriocarcinomas
1300
Seminomas are commonly confined wihtin the _______________
Tunica albuginea
1400
The term gonadal stromal tumor refers to a neoplasm containing 5 types of cells
1. Leydig
2. Sertoli
3. thecal
4. granulosa
5. lutein
1400
5 reasons to have testicular implants
1. undescended testicles
2. torsion of testicle
3. traumatic injury
4. cancer
5. small, deformed, or non-functioning testicle(s)
1400
Flow of semen from testicle out (6)
1. Seminiferous tubules
2. Tubuli recti
3. Rete testis
4. Efferent ductules
5. Ductus epididymis
6. Vas Deferens
1400
Mixed germ cell tumors include what 3 things?
1. teratoma
2. choriocarcinoma
3. yolk sac tumor
1400
3 types of benign cysts
1. tunica albuginea cysts
2. intratesticular cysts
3. epidermoid cysts
1500
4 testicular appendages
1. Appendix testis
2. Appendix Epididymis
3. Vas aberrans
4. Paradidymis
1500
5 things the spermatic cord consists of
1. vas deferens
2. arteries
3. pampiniform plexus of veins
4. lymphatics
5. nerves
1500
3 arteries that bring blood to the testicle
1. testicular
2. deferential
3. cremasteric
1500
What are the waveforms of blood flow to the testis (3):
1. Deferential: HIGH
2. Cremasteric: HIGH
3. Testicular: LOW
1500
Benign intratesticular lesions (3)
1. cysts
2. abscesses
3. calcifications
1500
Extratesticular lesions (6)
1. hydrocele
2. hematocele
3. pyocele
4. varicocele
5. extratesticular tumors
6. scrotal hernia
1500
3 types of epididymal lesions
1. cysts
2. spermatoceles
3. sperm granuloma
1500
4 types of germ cell tumors of the testicle
1. seminoma
2. teratoma
3. choriocarcinoma
4. mixed tumors
1500
3 layers of a teratoma
1. endoderm
2. mesoderm
3. ectoderm
1500
What 3 distal metastases may be the initial presentation of choriocarcinoma
1. lung
2. liver
3. brain