Pathology of Scrotum

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"Bear down" as if to have a bowel movement "Flex ab muscles" Dual Screen - Color Doppler Technique

Valsalva Maneuver

Most common form of testicular cancer in children

Yolk Sac tumors

Hematocele

a collection of blood within the scrotum

Monorchia

a condition in which only one testicle is present

Hydrocele

a fluid collection found within the scrotum

pyocele

a pus collection within the scrotum

Testicular Ectopia

a testicle that has taken a non-standard path through the body and ended up in an unusual location

Anorchia

absence of testicular tissue

hematocele

accumulation of blood around the testicles

Almost all prostate cancers are

adenocarcinomas

-History of adrenal hyperplasia -Elevated adrenocorticotropic hormone

adrenal rest

Variocele

an abnormal dilation of the veins of the pampiniform plexus

Hydrocele is most often found

between the layers of the tunica vaginalis

Peyronie Disease

buildup of fibrous plaque and calcification within the penis that results in painful curvature

sonographically this pathology resembles "Swiss cheese"

choriocarcinoma

microlithiasis

condition of small stones within the testes

spermatoceles

cystic dilations of efferent ductules of the epididymis

Adrenal rest

ectopic adrenal tissue caused by the migration of the adrenal tissue with the gonadal tissue during fetal development

Scrotal Pearl

extra-testicular calculus

tunica albuginea cyst

fluid collection within the tunica albuginea

95% of all testicular tumors are _____

germ cell tumors

polyorchidism

having more than two testes

Orchitis

inflammation of one of both testicles

Epididymitis

inflammation of the epididymis and/or testicle from an infection

Prostatitis

inflammation of the prostate gland

Choriocarcinoma sonographic appearance

irregular borders

-Higher risk for malignancies (testicular cancer) -Cryptorchidism -Klinefelter's syndrome - sex chromosome disorder -Infertility -Varicoceles -Testicular atrophy -Male pseudohermaphroditism

microlithiasis

When assessing for possible torsion, be sure to sample blood flow in the _________ of the testicle as well - not just along the periphery

middle

Sperm Granuloma

occurs as chronic inflammatory reaction to extravasation of spermatozoa developing at the site where the bloackage occurs

testicular abscess

occurs due to untreated epididymo-orchitis

testicular torsion

occurs when arterial blood supply is cut off

polyorchidism is most common

on the left side

associated with adrenal hyperplasia or "Cushing's Disease"

Adrenal Rests

-Nocturia -Increased urinary frequency -Sense of urinary urgency -Constant feeling of having a full bladder -Elevated PSA

BPH

May cause testicular infarction

Epididymitis

Most common cause of acute testicular pain for adults

Epididymitis

Pathology of the scrotum most commonly found from UTI or untreated STD

Epididymitis

Associated with elevated levels of hCG and AFP

Germ Cell Tumors

1% - 7% of all testicular tumors, most common bilateral secondary testicular neoplasm affecting men > 60 yo

Lymphoma

Benign Prostatic Hypertrophy (BPH)

Most commonly located within the transitional zone -Age-associated prostate gland enlargement that can cause urination difficulty -This type of prostate enlargement isn't thought to be a precursor to prostate cancer

Bacterial or viral infections can cause

Orchitis

What type of transducer is used during a scrotal examination?

"Hockey Stick" high frequency transducer

Penile trauma

- rupture of the erectile tissue - typically due to incorrect deviation during sexual trauma

Mets to Scrotum

-Rare -Primary tumor: may originate from **prostate or kidneys -less common sites: lung, pancreas, bladder colon, thyroid, or skin

normal scrotal wall measurement

2 and 8mm

Vascular impotence

Caused by vascular compromise to or within the penis that results in the inability to obtain or maintain an erection

Clinical findings of Pyocele

Elevated WBC Painful, swollen scrotum redness and warm to the touch

Second most common malignant neoplasm of the testicle

Embryonal Cell tumor

Elevated PSA Enlarged Prostate Blood in urine or semen Back pain, pelvic pain, thigh or hip pain Impotence Decrease in the amount of ejaculated fluid

Prostate Cancer

Hematospermia - blood in semen Painful ejaculation Perineal pain dysuria

Prostatitis

Rare, said to be either congenital or acquired Usually asymptomatic but can be associated with Zinner syndrome

Seminal Vesicle Cysts

This occurs in patients with a history of vasectomy:

Sperm Granuloma

Associated with extratesticular spermatoceles Located near mediastinum Can be single or multiple and size varies Can be Simple or Epidermoid More common in men over 40

Testicular Cyst

Most common type of benign testicular neoplasm

Testicular Epidermoid Cyst

This benign pathology is also known as keratocysts

Testicular Epidermoid Cyst

-Painful, swollen scrotum -Fever -Leukocytosis

Testicular abscess

Complex intratesticular mass Flow is around but not within the mass Mass that has no flow centrally, but increased flow around its margins May have a coexisting pyocele

Testicular abscess

-Simple cyst noted within testes -Whorled or onion skin appearance

Testicular cyst

This is one of the most urgent types of ultrasound exams! Needs to be preformed ASAP - If not found within 6 hours, it could lead to infertility or loss of testicle

Testicular torsion

acute scrotum

results from a direct blow to the scrotum due to injury

During a sonographic exam for acute scrotum what is the first thing we should look for?

rupture

Acute scrotum is also referred to as

scrotal trauma

Occurs when bowel, omentum or other structures herniate into the scrotum

scrotal/inguinal hernia

Most common malignant neoplasm of the testicle

seminoma

-Acute testicular Pain -Leukocytosis -Fever -Dysuria -Urethral discharge -Scrotal wall edema

signs and symptoms of Epididymitis

epididymal cysts

small clear cysts

This pathology can also look like testicular torsion appendage

sperm granuloma

testicular torsion is also known as

spermatic cord torsion

Acute scrotum clinical findings

swollen or discolored scrotum painful to the touch history of acute injury

Often exists as part of testicular mixed germ cell tumors

teratoma

Seen with a pyocele

testicular abscess

Signs and symptoms of testicular torsion

testicular pain pain in lower abdomen and inguinal region swollen scrotum N/V

Scrotal wall thickening is caused by:

testicular torsion inflammation/infection trauma Idiopathic - unknown cause

Cryptorchidism

the condition of having an undescended testis or testicles

Most commonly found in teens

torsion

True/False Yolk sac tumors always have increased blood levels of AFP

true

Small, anechoic cyst within the mediastinum of the testis

tubular ectasia of rete testis

Most common cause of correctable male infertility

varicocele


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