2. Scrotum

varicocele

a group of dilated veins caused by venous return obstruction

signs and symptoms of epididymal cyst

painless extratesticular scrotal mass

signs and symptoms of spermatocele

painless extratesticular scrotal mass

sonographic appearance of seminoma

solid, hypoechoic homogeneous mass

cremaster muscle

Covers testis and spermatic cord Raise and lowers testis to control temp

sonographic appearance of an adenomatoid tumor (scrotum) benign

small, solid, hypoechoic to hyperechoic

valsalva maneuver

a technique in which the patient is asked to bear down to increase the intra-abdominal pressure and aid in the diagnosis of varicocele and scrotal hernia

sonographic appearance of a scrotal tumor

solid hypoechoic intratesticular mass

sonographic appearance of an epidermoid cyst

solid hypoechoic intratesticular mass, usually with concentric hyperechoic layers (onion sign)

scrotum

the double pouch of the male that contains the testicles and part of the spermatic cord

vas deferens

the excretory duct of the testis; transports sperm from each testis to the prostatic urethra

What are sperm and where are they formed ?

the mature male sex of germ cell formed within the seminiferous tubules of the testes

testicular vein

the pampiniform plexus forms each testicular vein; the right testicular vein drains directly into the inferior vena cava (think, right to it!!") the left testicular vein drains into the left renal vein (think, it takes Longer)

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vas deferens (expels /propels sperm)

dilated veins of a varicocele will measure - >8mm - >4mm - <2mm - >2mm

>2mm

Omentum

A double fold of peritoneum

Hematoma

A swelling or mass of blood confined to an organ, tissue or space

Microlithiasis

Calcifications within the seminiferous tubules

mediastinum testis

Central linear structure formed by the convergence of multiple, thin septations within the testicle, which are invaginations of the tunica albuginea

cremasteric artery

aka external spermatic artery Small artery arising from the inferior epigastric artery, which supplies the peritesticular tissue, including the cremaster muscle

hyperemia

an increase in blood flow to the tissue

testicular artery

artery arising from the aorta just distal to each renal artery

Which of the following houses the male urethra? - Corpus spongiosum - Buck fascia - Bulbourethral gland - Corpus cavernosum

corpus spongiosum

pyocele

pus located between the visceral and parietal laters of the tunica vaginalis

Centripetal artery

terminal intratesticular arteries arising from the capsular arteries

A 23-year-old man presents to the sonography department with a history of infertility. Which of the following is associated with male infertility? - Spermatocele - Choriocarcinoma - Varicocele - Hydrocele

varicocele

Epididymis

A small, oblong body resting on and beside the posterior surface of the testes and consisting of convoluted to tubules 13 to 20 feet in length

Choriocarcinoma

An extremely rare, very malignant neoplasm

The lack of the normal fixation of the testis to the posterior scrotal wall is referred to as: - Klinefelter syndrome - Blue dot sign - Bell-clapper deformity - Cryptorchidism

Bell-clapper deformity

Mediastinum testis

The second portion of the tunica albuginea on the posterior surface of the testis

Which of the following would most likely resemble a solid intratesticular mass and be associated with Cushing syndrome? - Choriocarcinoma - Epidermoid cyst - Intratesticular varicocele - Adrenal rest

adrenal rest

What laboratory value can be assessed as a tumor marker to evaluate a patient for testicular malignancy? - Serum bilirubin - Amylase - Alpha-Fetoprotein - Adrenocorticotropic hormone

alpha-fetoprotein

deferential artery

arises from the vesicle artery and supplies the vas deferens and epididymis

Enlargement of the prostate in older men is most often caused by: - Prostatitis - Prostate cancer - Benign prostatic hypertrophy - Klinefelter syndrome

benign prostatic hypertrophy

The most common location of a hydrocele is: - Superior to the testis - Within the scrotal wall - Between the two layers of the tunica vaginalis - Between the tunica vaginalis and tunica albuginea

between the two layers of the tunica vaginalis

hematocele

blood located between the visceral and parietal layers of the tunica vaginalis

ejaculatory ducts

connect the seminal vesicle and the vas deferens to the urethra at the verumontanum

varicocele

dilated veins in the pampiniform plexus primary varicocele is usually on the left side ! can have palpable mass and cause infertility

Beta hCG

human chorionic gonadotropin is produced during pregnancy but is also secreted by certain testicular cancers

A simple fluid collection surrounding the testis is referred to as a: - Hematocele - Hydrocele - Varicocele - Spermatocele

hydrocele

Which of the following is consistent with the sonographic features of testicular abscess? - Hyperemic flow around the abscess but not within it - Onion skin sonographic appearance and hyperemic epididymis - Hyperemic flow within an anechoic mass - Hyperemic flow within the abscess but not around it

hyperemic flow around the abscess but not within it

All of the following are sonographic findings consistent with the diagnosis of testicular torsion except: - Hyperemic flow within the testis - Hypoechoic testis - Reactive hydrocele - Decreased intratesticular flow (as compared with the asymptomatic testis)

hyperemic flow within the testis

You have been asked to perform a study to rule out cryptorchidism. The term cryptorchidism denotes: - One or both of the testicles have a malignancy - That the testicle has torsed - One or both of the testicles have not descended into the scrotum - The patient has been kicked in the scrotum

one or both of the testicles have not descended into the scrotum

seminal vesicles

reservoirs for sperm located posterior to the bladder

Primary varicoceles are associated with all of the following EXCEPT: - Left-sided location - Retroperitoneal mass - Infertility - Palpable extratesticular mass

retroperitoneal mass

appendix testis

small oval structure located under the head of the epididymis

The exocrine function of the testicles is to produce: - Testosterone - Human chorionic gonadotropin - Alpha-Fetoprotein - Sperm

sperm

orchiopexy

surgical procedure done to fasten a undescended testicle into the scrotum or repair an acute testicular torsion

peronium

taint!

recurrent rami

terminal ends of the centripetal arteries that curve backward toward the capsule =straight arrow centripetal artery =curved arrow

cryptorchidism

testicles remain within the abdomen or groin and fail to descend into the scrotal sac, undescended testicle

Acute onset of testicular pain at rest is a common clinical finding with: - Testicular carcinoma - Hydrocele - Testicular trauma - Testicular torsion

testicular torsion

The endocrine function of the testicles is to produce: - Testosterone - Human chorionic gonadotropin - Alpha-Fetoprotein - Sperm

testosterone

The most common location of a varicocele is: - The right side of the scrotum - The left side of the scrotum - The inguinal canal - Within the testis

the left side of the scrotum

infarction

tissue death/necrosis that occurs due to lack of blood flow (can be caused by testicular torsion)

urethra

tubular structure that extends from the bladder to the end of the penis

Which of the following techniques is useful for providing sonographic evidence of a varicocele? - Valsalva maneuver - Sitting position - Pulsed Doppler - Right lateral decubitus position

valsalva maneuver

A dilated group of veins found within the scrotum is called a: - Varicocele - Spermatocele - Seminoma - Hydrocele

varicocele

What scrotal abnormality is caused by incompetent valves within the pampiniform plexus? - Testicular carcinoma - Testicular microlithiasis - Testicular torsion - Varicocele

varicocele

Blood supply to the penis

- 2 cavernosal arteries *lateral * parallel, linearm echogenic structures in center of corpora in sagittal plane - 2 dorsal arteries: dorsal - 2 dorsal veins * emissary veins perforate tunica albuginea and drain into dorsal veins * veins become compressed between stiff tunica albuginea and engorged, resulting in maintenance of erection

What are the 3 columns of spongy vascular tissue in the penis? Penis anatomy!!!!!!!!!!!!!!????

- Dorsal side: 2 corpora cavernosa (CC), * sinusoidal cavities are responsible for erection * tunica albuginea surrounds the CC - Ventral side: 1 corpus spongiosum *lies between the CC * Glans penis: bulbous end, and supports prepuce

what is Cowper's gland

- excretes pre-ejaculate - neutralizes urethra - may pick up sperm from previous ejaculations

Anatomy of the penis

- Radix: root - Corpus: body dorsal and is the superior in the flaccid ventral which is the inferior when flaccid

pudendal artery

Partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis

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body of epididymis

seminomas

germ cell tumors

What is the most common correctable cause of male infertility? - Varicocele - Chlamydia - Hydrocele - Testicular torsion

varicocele

Physiology of the penis

- arteries of penis dilate with blood upon stimulation - blood fills 3 spongy chambers of tissue - engorged tissues compress veins, severely limiting or eliminating venous flow - erection is maintained

Vas Deferens

- connects epididymis to ejaculatory duct (seminal vesicles) - smooth muscle - propels sperm forward - joins seminal vesicle, forming ejaculatory duct - 30cm in length - part of the spermatic cord - vasectomy

spermatocele

- cyst in the vas deferens containing sperm (vas deferens connects to the epididymis, tend to arise from head of epididymis) - retention cyst that involves the seminiferous tubules containing sperm

testis

- located in the scrotum

epidermoid ?

Pertaining to the epididymis of the skin

AFP

alpha fetoprotein level that may be elevated with hepatocellular carcinoma and certain testicular cancers

2

efferent ductules

sonographic appearance of cryptorchidism

homogeneous ellipsoid mass in inguinal canal

what is the corona of the penis

rounded base of glans

4

septa

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tunica vaginalis

tunica albuginea

- inner fibrous membrane surrounding the testicle - white, fibrous capsule that surrounds the testicle

Lymphoma

Growth of new tissue in the lymphatic system

Hernia

The protrusion of part of an organ through the wall that normally contains it

what are the segment of the epididymis

- Head: largest (15mm), superior, appendix epididymis - Body: posterolateral (<4mm) - Tail - ductus epididymis - vas deferens

pampiniform plexus

- Plexus of veins in the spermatic cord that drain into the right and left testicular veins - a network of veins that drains the epididymis and testis

what are the lobules of the testis

- Seminiferous tubules: make sperm, converge to form rete testis - Leydig cells: make testosterone - Bare area: posterior - Appendix testis: embryologic remnant

Causes of erectile dysfunction

- age - health: hypertension, low testosterone, peripheral vascular disease - venous leak: pelvic steal - arterial vasospasm - Peyronie's disease

Hematocele

Extratesticular hematoma

Incarcerated

Imprisoned, confined, restricted

Orchitis

Inflammation of a testis. May be caused by injury, mumps virus, or other infections.

a patient presents to the sonography department for a penile sonogram. He complains of painful curvature of the penis and impotence. What is the most likely diagnosis - Squamous cell carcinoma - Peyronie disease - Tinner syndrome - Testicular fracture

Peyronie Disease

Cryptorchidism

Testicles that do not descended into the scrotal sac

Inguinal canal

The canal carrying the spermatic cord

epididymis

anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single, convoluted epidydimal tubule

teratomas

congenital tumors that contain embryonic elements of all three primary germ cell layers

What is in the spermatic cord?

cremasteric muscle vas deferens testicular artery pampniform plexus possibly hernia sac genital branch of genitofemoral nerve

Peyronie's disease on U/S

curvature of the penis due to fibrous tissue deposits around the corpora cavernosa

epididymal cyst

cyst filled with clear, serous fluid located in the epididymis

sonographic appearance of orchitis

decreased echogenicity, possible hydrocele, increased blood flow, testicular atrophy in chronic orchitis

what does the median raphe do

divides the scrotum into two

Signs and symptoms of choriocarcinoma (MALIGNANT)

elevated hCG level with or without palpable mass

sonographic appearance of epididymitis

enlarged epididymis with decreased echogenicity, hyperemia, hydrocele

signs and symptoms of lymphoma/leukemia (scrotal)

enlarged testicles with or without palpable mass, known disease

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epi tail

Which of the following is a benign intratesticular mass that typically has a whorled or onion skin sonographic appearance? - Seminoma - Teratoma - Epidermoid cyst - Adrenal rest

epidermoid cysts

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epididymal head

Which of the following is not a component of the spermatic cord? - Epididymis - Testicular artery - Cremaster muscle - lymph nodes

epididymis

sonographic appearance of hydrocele

fluid collection anterolateral to surrounding testis

hydrocele

fluid formed between the visceral and parietal layers of the tunica vaginalis

sonographic appearance of infarction (scrotal)

focal hypoechoic lesion or entire testis

Signs and symptoms of hydrocele

general scrotal enlargement

What would be the most likely sonographic appearance of a seminoma? - Hyperechoic - Anechoic - Heterogeneous with calcifications - Hypoechoic

hypoechoic

sonographic appearance of lymphoma/leukemia

hypoechoic area or enlarged testicle with possible anechoic portions

sonographic appearance of a teratoma

hypoechoic to hyperechoic usually complex mass, possible shadowing

sonographic appearance of embryonal cell carcinoma (malignant germ cell tumor)

hypoechoic, may have echogenic areas or shadowing calcifications

sonographic appearance of varicocele

increased blood flow in prominent veins with valsalva, usually on left; vessels >2mm

orchitis

infection of the testis and epididymis most common cause is chlamydia -elavated wbc

Epididymitis

inflammation of the epididymis

epididymitis

inflammation of the epididymis signs and symptoms: scrotal pain, possible fever, discharge, usually elevated WBC count, UTI

abscess

localized collection of pus

signs and symptoms of seminoma

palpable testicular mass, rarely painful, possible microlithiasis

Signs and symptoms of embryonal cell carcinoma (malignant germ cell tumor)

palpable testicular mass, rarely painful, possibly elevated hCG

The most common location of prostatic cancer is the: - Peripheral zone - Transitional zone - Central zone - Verumontanum

peripheral zone

signs and symptoms of varicocele

prominent scrotal vessels, especially with standing, infertility

What is the most common cancer found in men? - Testicular cancer - Lung cancer - Liver cancer - Prostate cancer

prostate cancer

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rete testes

sonographic appearance of epididymal cyst

round or oval lesion predominantly anechoic, with enhancement, possible layering; possibly multiple

sonographic appearance of spermatocele

round or oval lesion predominately anechoic, with enhancement, possible layering

sonographic appearance of an abscess (scrotal)

round or oval with irregular wall, hypoechoic, anechoic, or mixed

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seminiferous tubules makes the sperm

A common cyst most often seen in the head of the epididymis that contains nonviable sperm is the: - Epididymal cyst - Tunica albuginea cyst - Spermatocele - Seminoma

spermatocele

Whats doing on

spermatocele and tubular ectasia of rete testis (vasectomy)

What is the most common malignancy of the penis? - Cystadenocarcinoma - Adenocarcinoma - Follicular carcinoma - Squamous cell carcinoma

squamous cell carcinoma

spermatic cord

structure made up of vas deferens, testicular artery, cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum

signs and symptoms of torsion

sudden severe testicular pain, nausea and vomiting

Orchiectomy

surgical excision of a testicle

Signs and symptoms of a hernia

swollen scrotum, pain

Signs and symptoms of infarction (scrotal)

testicular pain, history of inflammation, torsion or trauma

torsion

twisting of the spermatic cord

what is the frenulum or frenum of the penis

underside where foreskin is attached

signs and symptoms of testicular cyst

usually asymptomatic, occult, incidental

What is the anatomy of the scrotum

- scrotal sac -testis -epididymis - vas deferens - spermatic cord

what are the layer of the scrotum

- skin - Darto's muscle: responsible for climate control

Epididymis

- stores sperm - comma shaped - superior and posterolateral

scrotal sac

- stores testis - fibromuscular fibers - climate control

what does the scrotal sac contain

- testis - epididymis - vas deferens - spermatic cord

testis coverings

- tunica albuginea: mediastinum testis, divides into lobules - tunica vaginalis: 2 layers of peritoneum

Spectral and Color Doppler

-forward low resistance flow -scale low, color gain high

partial torsion

-high resistance blood flow

Peyronie's Disease

-painful, deviated erection -Repeated micro traumas -Fibrous plaques form in the tunica albuginea

infarction of testis

-ruptured tunica albuginea -hematocele -infarct

what is the size of a testis

5x4x3cm

Human chorionic gonadotropin

Hormone secreted by the placenta

Epididymoorchitis

Inflammation of the epididymis AND corresponding testis!!!!!!!!! most common male reproductive condition causing acute pain

tunica vaginalis

Membrane consisting of a visceral layer and a parietal layer lining the inner wall of the scrotum

sonographic appearance of torsion

initially, enlarged hypoechoic testicle with diminished or absent blood flow

sonographic appearance of choriocarcinoma (malignant)

intratesticular mass with mixed echogenicity

sonographic appearance of rupture (scrotal)

irregular testicular outline with hypoechoic or hyperchoic areas, extratesticular soft tissue

verumontanum

junction of the ejaculatory ducts with the urethra

dartos

layer of muscle underneath the scrotal skin that wrinkles the skin

Secondary varicoceles are most likely associated with all of the following EXCEPT: - Left-sided location - Right-sided location - Hepatomegaly - Renal mass

left sided location (most common location of a varicocele is at left side of scrotum)

testicle

male gonad that produces hormones that induce masculine features and spermatozoa

testicle

male gonad; one of two reproductive organs located in the scrotum

chlamydia

microoranisms that cause a wide variety of disease including urethritis

septa of testis

multiple septa formed from the tunica albuginea that course toward the mediastinum testis and separate the testicle into lobules

rete testis

network of the channels formed by the convergence of the straight seminiferous tubules in the mediastinum testis

All of the following are sonographic findings consistent with torsion of the testicular appendage except: - No intratesticular flow - Small hyperechoic mass adjacent to the testis - Reactive hydrocele - Scrotal wall thickening

no intratesticular flow

what is the meatus of the penis

opening of urethra on corpus spongiosum

Signs and symptoms of orchitis

pain, fever, nausea, vomiting, exquisitely tender scrotum, elevated WBC, UTI, or trauma

signs and symptoms of rupture (scrotal)

painful to touch, recent trauma, scrotal edema

Signs and symptoms of adenomatoid tumor (scrotum) benign

painless extratesticular nodule

Signs and symptoms of epidermoid cyst

palpable testicular mass

signs and symptoms of a teratoma

palpable testicular mass, rarely painful

sonographic appearance of testicular cyst

round or oval, anechoic, thin walled, acoustic enhancement

scrotum

sac containing the testes and epididymis

sonographic appearance of a hernia

scrotal mass with variable echogenicity pattern; peristaltic motion may be identified

Signs and symptoms of an abscess (scrotal)

scrotal pain, fever, nausea and vomiting, history of UTI, possibly elevated WBC count

signs and symptoms of epididymitis

scrotal pain, possible fever, discharge, usually elevated WBC count, UTI

Zinner syndrome consists of unilateral renal agenesis, ejaculatory duct obstruction, and - Prostate cancer - Seminoma - Bulbourethral stones - Seminal vesicle cysts

seminal vesicle cysts (ipsilateral)

Spermatogenesis occurs within the: - Tunica albuginea - Rete testis - Mediastinum testis - Seminiferous tubules

seminiferous tubules

The most common germ cell tumor of the testis is the: - Yolk sac tumor - Embryonal cell carcinoma - Seminoma - Teratoma

seminoma associated w/ increase in AFP and hCG!!!!!!!!!!!!!!!

What is the most common malignancy of the testicles? - Embryonal cell carcinoma - seminoma - choriocarcinoma - spermatocele

seminoma (germ cell tumor)

tunica vaginalis

serous membrane that surrounds the font and sides of the testicle2

A 7-year-old boy presents to the emergency department with acute testicular pain localized to the superior pole of his right testis. What is the most likely diagnosis? - Testicular torsion - Hydrocele - Torsion of the testicular appendage - Yolk sac tumor

torsion of the testicular appendage

the blue dot is indicative of: - testicular torsion - Epididymitis - Orchitis - Torsion of the testicular appendage

torsion of the testicular appendage

The most common location of BPH is the: - Peripheral zone - Transitional zone - Central zone - Verumontanum

transitional zone

vas deferens

tube that connects epididymis to the seminal vesicles vasectomy here

During a sonographic examination of the right testis, you visualize multiple small cysts located along the mediastinum testis. What is the most likely diagnosis? - Epididymitis - Tubular ectasia of the rete testis - Multiple spermatoceles - Epidermoid cysts

tubular ectasia of the rete testes

Reasons for a penis ultrasound

- evaluate for arterial insufficiency - erectile dysfunction, unable to obtain or maintain an erection - Peyronie's disease: curved painful penis with an erection, it is a connective tissue disorder with scar tissue buildup in tunica albuginea from chronic inflammation, can result in erectile dysfunction

signs and symptoms of scrotal tumor

painless testicular mass or enlargement

Signs and symptoms of cryptorchidism

palpable mass in inguinal canal

malignant testicular tumors ? GENERAL INFO NEED TO KNOW

-Most intra-testicular lesions are malignant Symptoms: -palp mass -chronic pain -heaviness in scrotal sac * most common is germ cell tumor (serinoma) - has elavated AFP, hCG (epidermoid cyst = top right; still remove teste)

Hydrocele

Accumulation of serous fluid in the tunica vaginalis testis

Which of the following best describes a spermatocele? - The most common malignant neoplasm of the scrotum - A benign intratesticular cyst - A cyst, found within the head of epididymis, that may contain debris - A dilated group of veins found within the scrotum

a cyst, found within the head of the epididymis, that may contain debris