Chapter 28 Scrotal Mass and Scrotal Pain (DMS120)

any trauma to the scrotum can cause bleeding within the testicle this is called a testicular hematoma. The scrotum is likely to be painful.

unless scanned immediately the intra testicular hematoma is heterogeneous and septation may be present.

signs and symptoms of testicular cyst

usually asymptomatic. occult. And incidental. Sonographic findings include round or oval. Anechoic. thin-walled. Acoustic enhancement.

signs and symptoms for hydrocele

General scrotal enlargement. Sonographic findings include fluid collection anterolateral to or surrounding the testis.

infarction occurs in a testy after focal or diffuse ischemia from various ideologies. Typically there is a history of torsion or trauma and there is no palpable abnormality. if a exam is done soon after the precipitating event an infarct appears as

a focal hypoechoic mass of any size including complete involvement of the testis. Indistinguishable from a true neoplastic Mass. They become smaller over time and do not have vascularity on Doppler.

a hematocele is a collection of blood in the Peri testicular space. Camaro sales are similar to hydrocele on exam and must be considered in patients with a history of recent trauma. Including torsion or scrotal and inguinal surgical procedures

a hematocele is seen as a complex collection around the testis. Usually with septations and varying amounts of cystic vs. solid components. Depending on the age of the hematoma.

if uncorrected or with greater rotation arterial flow is absent. The testicular blood supply in pre-adolescent boys is normally minimal so optimization of Doppler settings for low-flow is imperative.

a hydrocele may be seen. Hyperechoic or heterogeneous areas of infarction can develop. And eventually complex or cystic areas of necrosis are seen. A small and homogeneous or hypoechoic testicle can be seen with chronic torsion.

symptoms and signs for cryptorchidism

a palpable mass in the inguinal Canal the sonographic findings include a homogeneous ellipsoid mass in the inguinal canal.

signs and symptoms for embryonal cell carcinoma

a palpable testicular Mass. rarely painful. Possibly elevated HCG. Sonographic findings include hypoechoic. May have echogenic areas or shadowing calcification.

if testicular rupture is left untreated the patient can develop gangrene and may endure chronic scrotal pain. This is a Urologic emergency because prompt surgical intervention salvages 90% of ruptured testis.

a ruptured testicle has an irregular outline and tissue outside the Tunica that is hyperechoic or isoechoic to normal testicular tissue.

seminomas are the most common germ cell tumor accounting for approximately half the tumors. They readily metastasize to retroperitoneal lymph nodes and a significant number of these are found only

after the discovery of the distant disease. Despite their medaesthetic tendency seminomas respond well to therapy and are the most likely germ cell tumors to successfully be treated.

a pyocele is a collection of Peri testicular pus in patients with an inflammatory scrotal condition or who have sustained scrotal trauma. a patient presents with an enlarged scrotum of varying degrees and may exhibit pain. Redness. And localized warmth.

also likely to have an elevated white blood cell count and low grade fever if he has an active infection.

the serum tumor markers Alpha fetoprotein. Human chorionic gonadotropin or HCG. And lactate dehydrogenase can be helpful in decisions regarding management of testicular cancers but not for screening asymptomatic patients.

although some testicular cancers cause pain most do not.

a normal epididymis may have a perceptible tubular appearance and has an echogenicity that is less than the testicle.

although the head may be more echogenic than the rest of the epididymis.

sonographic findings for an inguinal undescended testicle is identified as an ovoid soft tissue mass in the inguinal canal. Often recognized as the testis and epididymis.

an inguinal testicle is typically smaller than a normally located testicle. the echotexture of a normal undescended testicle is homogeneous and hypoechoic. Color reveals diminished blood flow especially in prepubescent boys.

intratesticular absences are uncommon. Usually resulting from epididymo-orchitis. But other causes have been reported. clinically the patient has a swollen and tender testi and the abscess is discovered incidentally.

an inter testicular abscess may appear as a homogeneous hypoechoic or anechoic area and maybe complex and a regular with increased blood flow outside of abscess on color Doppler. A concurrent pyocele is possible

epidermoid cyst accounts for only 1% of testicular neoplasms. They are benign keratin containing cysts with an onion skin lamellar architecture. most commonly discovered as well circumscribed painless testicular mass in post pubertal boys and men 40 years old or younger.

appear as well defined hypoechoic round or oval masses and although there cysts. Acoustic enhancement is absent. Concentric laminar architecture Within These lesions sometimes generates a whorled appearance that is suggestive of the diagnosis.

signs and symptoms for epididymal cyst

famous extra testicular scrotal Mass. Sonographic findings include a round or oval lesion predominantly anechoic. With enhancement. possible layering. Possible multiple.

a pyocele appears as a complex. Sometimes septate fluid collection surrounding the testes. Unusual presentations include relatively homogeneous and echogenic material around the testes for a discrete Mass near the testes.

gentle transducer pressure sometimes creates visible movement of the pyocele at course. They can be any size but rarely achieved several centimeters in greatest dimension.

epidermoid cysts also have a suggestion of sonographic appearance with the absence of internal vascularity on Doppler exams.

if these characteristics are seen it must be reported so that surgical planning can allow for the possibility of a testis sparing enucleation.

signs and symptoms for epididymitis

scrotal pain. Possible fever. Discharge. Usually elevated white blood cell count. UTI. Sonographic findings include an enlarged epididymis with decreased echogenicity. Hyperemia. Hydrocele.

scrotal hernias are inguinal hernias that enter the scrotum. They may contain serious fluid contained by peritoneum. Small ball. Colon. Mesentery. Are omentum. Abdominal contents are able to enter the

scrotum because the processes vaginalis persist after birth or recanalizes later. there are two types of hernias. Indirect and direct.

the presence of microlithiasis. Or tiny non shadowing echogenic foci in a testis with a solid tumor is suggestive of

seminoma. Although screening with sonography in asymptomatic men with no risk factors for seminoma has not been shown to be beneficial.

sonographic findings for hernias reveals a mass of greatly variable echogenicity and echotexture depending on what structures are herniated into the scrotum. maybe variably echogenic fluid with or without a visible hernia Sac or a solid mass of varying complexity.

shadowing from Air may be identified. If peristaltic motion is identified the diagnosis is confirmed. gentle pressure May demonstrate reduction of hernia in proximal scrotal space and valsalva maneuver May force hernia deeper into the Hemi scrotum.

previously healthy 29 year old male reports 12 days of fatigue and malaise with occasional nausea. Physical exam shows a small tender palpable nodule in lower pole of right testi. exam shows small cystic mass. Mostly solid and complex. Occupies most of right testi diagnosis?

small palpable nodule is a benign Tunica albuginea cyst. Incidental finding. Significant finding is complex intratesticular Mass which is highly suggestive of carcinoma. cannot distinguish between teratoma and mixed germ cell tumor or choriocarcinoma.

most extra testicular processes are benign where is most intratesticular findings are malignant. However

sonography can rarely distinguish between a benign and malignant solid lesion. Meaning all solid intratesticular masses are considered significant.

near or at the inferior pole of the testes the duck turned back toward the upper pole. Deconvolutes . and enlarges slightly to become the ductus deferens. Which exits the scrotum as part of the

spermatic cord. Each codon compartment or Hemi scrotum is lined by Tunica vaginalis. A serious membrane that also covers the testicle and epididymis. And encloses the potential Peri testicular space.

a hydrocele is an abnormal amount of serious fluid in the Peri testicular space. they may be unilateral or bilateral and can occur at any age. Congenital hydroceles are common in newborn boys because

the processus vaginalis. The passage between the abdomen and the scrotum may not obliterate for sometime after delivery.

testicular torsion results when the testis rotates within the scrotum. Twisting the spermatic cord. this twisting compresses or are Clues the testicular vessels and result in decrease or loss of blood flow to and from the testis.

two types I'm just a girl torsion are intravaginal and extra vaginal. Extra vaginal torsion is rare and is seen most frequently in newborns.

acquired hydrocele as can occur at any age and have many causes including trauma. Infection. Infarction. Torsion. And testicular neoplasms. The patient usually has

unilateral painless scrotal enlargement. From minimal to large enough to alter gate. Most hydrocele transillumination on clinical examination.

stromal cell tumors arise from leydig cells between the seminiferous tubules and sertoli cells within the seminiferous tubules walls

leydig cells and sertoli cell tumors are usually benign.

malignancies that infiltrate the testicles are most often hypoechoic and do not distract the vascular or an atomic architecture of the testes.

lymphoma and Leukemia are likely to be hypervascular on color Doppler. An absence of pain AIDS in rolling out information.

signs and symptoms for varicocele

prominent scrotal vessels. Especially with standing. Infertility. Sonographic findings include increased blood flow and prominent veins with valsalva maneuver. Usually on left side. Vessels over to 2 mm.

tubular ectasia of the rete testis is epididymal obstruction from various causes including vasectomy and Trauma. And can result in cyst like dilation of the rete testis.

rete testi ectasia appears at the mediastinum as innumerable small cysts. Important to confirm the cystic nature of the rete testis ectasia to avoid mistaking this for a hypoechoic solid lesion.

symptoms and signs of testicular abscess

scrotal pain. Fever. Nausea and vomiting. History of UTI. Possibly elevated white blood cell count. Sonographic findings are a round or oval with a irregular wall. Hypoechoic. Anechoic. Or mixed.

surgical correction of inguinal cryptorchidism is called orchiopexy. and it moves the end descendant St to the scrotal sac and attaches it there.

Severe conditions are associated with the history of cryptorchidism including infertility. Cancer. and Scrotal hernia

what testicular rupture the intratesticular appearance can be Complicated by hematoma replacing seminiferous contents.

The tunical rent may be seen. color doppler May indicate absence or decreased intratesticular blood flow or localized hyperemia from the trauma

brother found in its pure form or as part of a mixed germ cell tumor the presence of choriocarcinoma is associated with the least favorable prognosis for long-term survival

Tumors usually manifest as a mass with mixed echogenicity. Not only because of the Mist histologic nature of these tumors but also because of the possible presence of hemorrhage. Necrosis. And calcifications.

the testicles are to avoid spermatogenic endocrine glands separated from each other within the scrotum by the scrotal septum. Each testicle has a capsule of fibrous connective tissue called the Tunica albuginea.

at the posterior aspect of the testicle the tissue of the Tunica albuginea enters the testicle to form the mediastinum testis and then extends towards the outer capsule as numerous SEPTA. Which create lobules that house the spermatogenic seminiferous tubules.

indirect hernias are more common than direct hernias. Both patients have a swollen scrotum of variable size that contains our palpable Mass. Incarceration occurs when the abdominal structures are no longer able to pass

between the abdomen and scrotum. Potentially causing the blood supply of the herniated tissue to be compromised. likely to be painful. If not surgically fixed the tissue becomes ischemic. Then infected. And finally necrotic and gangrenous.

epididymal cyst are serious fluid-filled cyst that occur anywhere in the epididymis. Spermatocele Czar cystic dilations of the epididymal duct uo's containing spermatozoa and other debris. & usually occur in the head.

both are coming. It's large enough to be palpable cysts and spermatoceles are discernible as a nodule separate from the testis. Although larger lesions May manifest as generalized painless scrotal enlargement.

varicoceles can be primary caused by an incompetent valves in the internal spermatic veins. Or secondary caused by

compression of the testicular vein by an extrinsic process such as a retroperitoneal Mass. Primary varicoceles can occur at any age and is a correctable cause of male infertility.

the sonographic findings for embryonic cell carcinoma is usually seen as a hypoechoic. And homogeneous or heterogeneous mass in the testicle. the tumor May

distort but normal Contour of the testicle when invasion of the Tunica albuginea occurs. If calcifications are present they tend to be bulkier than microlithiasis and me shadow.

normal testicles are homogeneous and mildly echogenic except for the mediastinum testis which is hyperechoic. is a variable thickness and runs along the posterolateral side of the testicle and a cranial caudal orientation.

each testicle is approximately 5 cm by 3 cm by 2 cm in size. The Peri testicular space normally contains small amounts of serious fluid.

symptoms and signs for choriocarcinoma

elevated HCG level with or without palpable Mass. Sonographic findings include an intratesticular Mass with mixed echogenicity.

pure choriocarcinoma are the rarest germ cell tumors. Choriocarcinoma is more often part of a mixed tumor found in about 23% of that kind of germ cell tumor. And the most common age group is 10 to 30 years old.

elevated levels of HCG are found in 100% of men with choriocarcinoma as making gynecomastia a common sign. men with this type of malignant testicular neoplasm can have breast enlargement from elevated HCG levels.

most solid intratesticular masses are malignant and half of the tumors are of primary germ cell origin. Germ cell testicular cancer can be seminomatous or nonseminomatous germ cell tumors. Including

embryonic cell carcinoma. Teratoma. And choriocarcinoma. pure nonseminomatous germ cell tumors uncommon. We're mixed germ cell tumors containing at least two of the types are second only to seminoma in incidents.

signs and symptoms of Lymphoma or leukemia

enlarged testicle with or without palpable Mass. Known disease. Sonographic findings include a hypoechoic area or enlarged testicle with possible anechoic portions.

sonographic findings for epididymitis includes in the early stages the tail is enlarged and card after shows markedly increased flow in the affected area. With progression the entire epididymis

enlarges and becomes hyperemic. And a reactive hydrocele May develop. If it becomes chronic the epidermis thickens and becomes focally echogenic. And calcifications maybe evident.

lymphoma is the most commonly occurring testicular cancer in elderly men. Where as testicular leukemia is often seen

in children with the disease. Testicular lymphoma is commonly bilateral. Advanced stages of these diseases can cause General enlargement of the testicle.

he hydrocele appears as a fluid collection next to or around the testis. large hydrocele Tsar better demonstrated with dual Imaging or an extended field of view.

in chronic hydrocele zeckos may be seen within the fluid. Documenting acoustic streaming with such a hydrocele confirms the diagnosis.

varicoceles appear as dilated fluid-filled tubular structures in the posterolateral aspect of the scrotum measuring greater than 2 mm. Echogenic blood may be seen moving slowly through the veins. But color Doppler is essential

increased flow is identified within the prominent vein when the patient performs the valsalva maneuver and ask and while the patient is standing.

cryptorchidism manifests as the absence from the scrotum of one or both testicles in a normal fetus the testicles descend through the processes vaginalis into the scrotal sac before delivery. And failure of either to arrive in the scrotum

is cryptorchidism. location of undescended testes can be anywhere. but 80% are palpable in the inguinal canal.

appendix testis and appendix epididymis torsion are the most common cause of acute scrotal pain in prepubescent boys. and clinically manifest the same as testicular torsion.

it is not considered a surgical emergency and is treated conservatively with non steroidal anti-inflammatory drugs and rest.

in appendix testis and appendix epididymis torsion a septate hydrocele is almost always present and the torqued appendage is enlarged. And has variable echogenicity. It does not have internal blood flow.

it's imperative to make the distinction between testicular torsion and appendiceal torsion when evaluating an acutely painful scrotum. Especially in younger patients.

every solid intratesticular Mass must be considered

malignant until proven otherwise. Sonography approaches 100% accuracy and distinguishing a solid Mass from cystic mass but is poor for distinguishing whether a solid into testicular mass is malignant or benign.

epididymal cyst and spermatoceles are indistinguishable sonographically. they may appear as anechoic simple cyst. Or

may contain find low-level Echoes. Sometimes with precipitative layering. neither of them is of clinical significance in less large enough to be symptomatic. Spermatocele tend to be solitary whereas epididymal cysts are often multiple.

embryonic cell carcinoma typically occurs in men 20 to 40 years old and is the second most common testicular cancer. Found in Pure or mixed form in 40% of primary testicular neoplasms.

metastasis can occur through the bloodstream and lymphatics. These cancers are more aggressive than seminomas.

testicular cysts are purely cystic lesion seen within the testicle and are true cysts. Most likely originating in the rete testis. can be tiny and barely perceptible. for they can nearly replace the testicular tissue.

most are not appreciated on physical exam and are identified incidentally. These lesions appear as well defined anechoic areas with smooth distinct walls and deep acoustic enhancement.

adenomatoid tumor is a very commonly find solid mass in the epidermis. It is benign and manifests as a hard. Discrete. Extra testicular nodule. Usually in a tail. Typically appears in the third to fifth decade of life.

most commonly appears as a well circumscribed extra testicular solid Mass with Eckrich necessity ranging from hypoechoic to eiber colic. Most are less than 2 cm in size but can be 5 cm.

leydig cell tumors are also called interstitial cell tumors. 15% or malignant which makes them the most common non germ cell tumor of the testy.

most commonly occur from the 3rd through the 6th decade of life and may produce excessive amount of either estrogen or testosterone causing feminization or virilization.

all types are usually discovered as a hard testicular mass or as a friend testicular enlargement on physical exam. early discovery of retroperitoneal or mediastinal metastasis often precipitates the discovery of

non palpable primary testicular germ cell tumors. Patients younger than 50 account for nearly all testicular germ cell tumors.

sperm granulomas are discreet extra tubular collections of granulomatous spermatozoa that occur at the epididymis or really testis and men who have had a vasectomy. Or less frequently trauma.

on physical exam they are painless. palpable. firm. Epididymal usually less homogeneas than adenomatoid tumors. I may have areas of particularly bright echoes. in the rete testis it appears as an intratesticular lesion.

patients with epididymitis may have elevated white blood cell counts. It is usually unilateral but it may be bilateral.

orchitis is inflammation of the testes. Usually occurs as progression into the testicle of untreated epididymitis. Resulting in epididymo-orchitis.

signs and symptoms for orchitis

pain. Fever. Nausea and vomiting. Exquisitely tender scrotum. Elevated white blood cell. UTI. Or trauma. Sonographic findings include decrease echogenicity. Possible hydrocele. Increased blood flow. Testicular atrophy in chronic arthritis.

signs and symptoms of rupture

painful to touch. Recent trauma. Scrotal edema. sonographic findings include a regular testicle outline with hypoechoic to hyperechoic areas. Extra testicular soft tissue.

signs and symptoms for adenomatoid tumor

painless extra testicular nodule. sonographic findings include a small solid hypoechoic or hyperechoic nodule.

signs and symptoms for spermatocele

painless extra testicular scrotal Mass. Sonographic findings include round or oval lesion predominantly anechoic. With enhancement. Possible layering.

signs and symptoms for stromal tumor

painless testicular mass or enlargement. Sonographic findings include solid hypoechoic intratesticular Mass.

signs and symptoms for teratoma

palpable testicular Mass. Rarely painful. Sonographic findings include hypoechoic to hyperechoic usually complex Mass. Possible shadowing.

signs and symptoms of seminoma

palpable testicular Mass. Really painful. Possible microlithiasis. sonographic findings include a solid hypoechoic homogeneous Mass.

symptoms and signs for epidermoid cyst

palpable testicular Mass. Sonographic findings include a solid hypoechoic intratesticular Mass. Usually with concentric hyperechoic layers.

determination of whether leydig cell tumors are benign or malignant with histopathologic examination alone is often difficult. And the presence of metastatic disease Merrillville the malignant nature of these cells.

patients normally have painless enlargement of the testicle or a palpable Mass. appear as solid intratesticular mass. hypoechoic. Hemorrhage and necrosis common. may see cystic areas. benign but sonography cannot distinguish between benign and malignant tumors.

epididymitis accounts for most acute inflammatory disease of the scrotum. Painful swelling. Redness. Skin warm. And thickening. And hydrocele. Are strongly suggestive of information.

patients with acute epididymitis have excruciating pain and may have urethral discharge. because the most frequent etiology of this is bacterial UTI. but it may also be viral in origin.

signs and symptoms for torsion

sudden severe testicular pain. Nausea and vomiting. Sonographic findings initially are in large hypoechoic testicle with diminished or absent blood flow.

signs and symptoms for a scrotal hernia

swollen scrotum. Pain. Sonographic findings include a scrotal mass with variable echogenicity pattern. Peristaltic motion may be identified.

teratomas may contain hair. Bone. Teeth. And other tissue types. Generally seen in neonates. Pre-pubertal boys. And men 25 to 35 years old. When found in younger patients

teratoma is usually benign. But an older patients 30% are malignant. prognosis in patients with malignant teratomas is less favorable than in patients with either seminoma or embryonal cell tumors

signs and symptoms of infarction

testicular pain. History of inflammation. Torsion. Or trauma. Sonographic findings include focal hypoechoic lesion or entire testis.

rupture of the testicle sometimes called testicular fracture results when the Tunica albuginea is ripped or cut by blunt or sharp trauma. Blunt trauma is more common. Damage the capsule allows

testicular tissue to be pushed into the Peri testicular space. exam reveals are scrotum extremely tender to the touch. Usually with edema. Making the physical exam difficult.

Tunica albuginea cyst form in the Tunica albuginea and are typically present in men 30 to 50 years old. Range in size from 2 mm to 3 cm but most are less than 1 cm in diameter. There painless and palpable at the testicular surface. as a classic Bebe or P presentation

these lesions appear as well defined round or oval red anechoic areas at the peripheral edge of the testis with or without deep enhancement.

sonographic findings for teratomas are usually well-differentiated histologically. depending on which tissue component are present.

these massive maybe hyperechoic. Hypoechoic. Or complex. And often demonstrate shattering and cystic areas.

but infiltrative testicular process lymphoma and Leukemia are nearly always metastatic manifestations of advanced disease

they are rare accounting for a very small portion of solid intratesticular masses.

a varicocele is a network of veins. the Pampeniform plexus. dilated going to increased venous pressure. It may be palpated as a sometimes painful cluster of tubular structures next to or superior to the testis.

they are usually found on the left because the left testicular vein is longer and enters the left renal vein at a right angle creating greater resistance to flow. Most are extra testicular.

sertoli cell tumors are usually benign. But they're Kurt equally at all ages. unlike leydig cell tumors. patients usually have painless enlargement of the testicle or a palpable Mass. When they are malignant

they can secrete estrogen. Causing some patients to have gynecomastia. sonographic appearance is nearly identical to leydig cell tumors.

in the acute phase of where China's the involved areas of the testis appear less echogenic than the normal test e. I bring you a develops throughout the testy. Later the scrotal wall Maybe

thickened and hyperemic. And long-term chronic arthritis the testicle becomes atrophic and heterogeneous.

intravaginal torsion occurs most commonly in adolescents and adults. Most testicular torsion occurs when the testicle is suspended within the Hemi scrotum by a stalk of spermatic cord. Rather than having the typical Broad attachment.

this is the so-called Bell Clapper anomaly. patients experienced sudden severe pain during strenuous physical activity or sleep. Some patients have nausea and vomiting.

scrotal pain is nearly always the result of inflammation or torsion. Information typically results from retrograde progression of a UTI but can also be caused bytrauma.

torsion is a result of twisting mechanical forces on scrotal structures. In addition to torsion and inflammation trauma can cause hematoma. hematocele. And testicular rupture.

the seminiferous tubules converge at the mediastinum to form the release testis. A network of microtubules which gives off several efferent ductules. The epididymal had it comprises that's kind of related efferent ducts rules that

transports spermatozoa out of the testes into the epididymis. Conduct rules of the head converge to become a single coil duct. But epididymal body and tail. Passing next to the testis from the upper pole towards the lower Pole.

scrotal pearls are calcifications within the Peri testicular space. they are thought to be caused by epididymitis. Testicular torsion. Torsion of the appendix testis. Or appendix epididymis. Information. Or chronic hydrocele.

usually silent but sometimes palpable. highly echogenic and sometimes have a less echogenic fibrous rind or concentric rings of varying echogenicity. more likely seen with a hydrocele and may not be noticeably mobile. Although calcified they may not shadow.

sonographic findings for seminoma are usually a hypoechoic mass that is homogeneous are those scattered hyperechoic areas May occasionally be seen. They're usually unilateral and maybe

very small in size or completely replace normal testicular parenchymal. if they do they tend to be heterogeneous or appear multilobular.

the timing of diagnosis for torsion and correction is critical to the prognosis. I salvaged rate of 80% to 100% is found in patients who undergo do you torsion and orchiopexy within 5 to 6 hours of onset of pain.

viability rate decreases to 70% after 6 to 12 hours and 20% if surgery is delayed greater than 12 hours.

with orchitis initially a localized area of test e might be inflamed. With the entire gland eventually becoming involved.

viral causes of arthritis include months. Influenza. And tonsillitis. Patients may have a fever. Nausea. And vomiting. If the disease is untreated areas of necrosis are abscess May develop.

sonographic findings for torsion depend on the duration and degree of rotation. Early or partial torsion occludes venous outflow before arterial inflow causes venous congestion and edema.

will see an enlarged hypoechoic testy with diminished I resistance arterial flow on Doppler. A Whirlpool sign is seen 96% of the time above or posterior to effective testis. Appearing as a spiral or donut shape on grayscale or color.