#7 - Male Reproductive Imaging

Peritoneum

The lining of the Tunica Vaginalis in the scrotum was originally (embryologically) the lining of what?

Varicocele

This testicular color Doppler taken during a valsalva maneuver shows?

Acute Epididymitis (in setting of hydrocele) Notice the epididymis is enlarged and hyperemic in both the head and body.

Two of the same photo, one with Doppler, what is diagnosis?

Pampiniform

A varicocele occurs from the veins within the ______________________ plexus dilate.

Strangulated indirect inguinal hernia

?

Testicular torsion, notice no blood on Doppler.

?

Scrotal calculus

?? (Doppler doesn't matter in this one)

Intratesticular = Malignant Extra = Benign

Between Intratesticular and Extratesticular masses, which is usually malignant and which is usually benign?

Tubular ectasia of rete testis Usually thought to occur secondary to obstruction in the epididymis or efferent ductules.

Bilateral (more commonly) dilation of the rete testis is called what? And is a result of what?

Seminiferous tubules, converging posteriorly until they drain into the rete testes (in the testicular mediastinum). The Rete testes converge to form efferent ductless, which pierce through the tunica albuginea to form the head to the epididymis. These unite to form a single highly convoluted tubule in the body of the epididymis emerging out the tail as the vas deferens.

Describe the 'parts' of the seminiferous tubule turning into the vas deferens.

Left = epididymal head Right = Epididymal tail Middle = the nut

Describe what is indicated by the white arrows (3) on this ultrasound of a normal testes.

May result in congenital hydrocele Risk factor for inguinal hernia

Failure of closure of the tunica vaginalis may result in ____________________ and is a risk factor for _________________.

Shown (nub) is appendix testis - a remnant of the mullerian system. Bottom left = Epididymis Right = Testis Top = scrotal skin, muscle and facial layers Notice that this is in the setting of a hydrocele, hence the large amount of hypoechoic nothingness

Kind of a lot going on here, try your best.

Skin Dartos Muscle/fascia External Spermatic Fascia Cremasteric muscle and fascia Internal spermatic fascia

Name the layers of the scrotum starting from the skin moving inwards to the testicle. (5 layers)

Tubular ectasia of the rete testis is shown. This is a dilation of the rete testes that if thought to occur secondary to obstruction in the epididymis or efferent ductless. May look like a mass, but is really just a series of dilated tubules.

Originally on imaging, the doc thought they saw a mass posterior/superior aspect of the testes. What is actually shown and how does this occur?

This is a testicular torsion, at 24 hours its gonna be dead. Orchiectomy is gonna be next

Pt states presenting symptom associated with this Doppler scan started 24+hours ago. What is next treatment step most likely?

Communicating would mean the tunica vaginalis did not fuse completely during development (likely congenital) and the fluid found in the tunica vaginalis is coming from the peritoneum. Non-communicating would be where there is no connection between the hydrocele and the peritoneum and the fluid comes from the mesothelial lining of the tunica vaginalis.

What are the differences between a communicating and non-communicating hydrocele?

Torsion of Appendix Testis "Blue Dot sign" - this is only present in 21% of cases but you see it everywhere in lit

What is dx? What is this sign called?

Mediastinum of the testis where the rete testes form the efferent duct leading to the head of the epididymis.

What is shown by the white line on the left?

Simple hydrocele Notice it is completely enveloping the testis (except for the 'bare' area indicated by the arrow). In this demo, most common cause are due to prior epididymitis.

What is shown in this scrotal ultrasound of a 28 year old man? What does the arrow point to? What is the most common cause of this condition in this demographic?

Two epididymal cysts

What is shown on the left likely contributing to the Rete Testis dilation (ectasia) on the right?

Epididymal Cyst Could be true epithelial lined cyst or spermatocele Doesn't matter either way, both benign.

What is shown on the longitudinal US of a testicle? What are the two possible causes? Which is more sketch?

Serpiginous, anechoic tubules oriented along the mediastinum testis, a finding pathognomonic for DILATED rete testis Should get further examination

What is shown on the transverse US of the left testis shown here?

Seminoma almost completely replacing the left testis

What is shown on this Axial T2 MR shows whattttt

Cysts of the epididymis causing tubular ectasia (dilation) of the rete testis

What is shown on this Sagittal grayscale US of the testis?

Testicular Microlithiasis Multiple tiny calcification Foci Without any other risk factors, ur fine, but if you DO have others, gotta follow up.

What is shown on this Sagittal grayscale ultrasound of the R testis?

Notice small cystic 'tag' of tissue projecting from epididymis = Appendix Epididymis - a remnant from the wolffian system. These can rarely torse and cause scrotal pain, but theyre usually fine. Bottom right is the tunica albuginea Anytime you see a clearly define appendix anything, it'll be in the setting of a hydrocele (as seen here) just cause it makes it easier to see.

What is shown on this longitudinal ultrasound? Is the pathology shown dangerous?

Bell clapper deformity Notice that the testis lies horizontally and the tunica vaginalis extends up over the spermatic cord so that the testis is suspended within the tunica vaginalis by the spermatic cord. TORSION

What's the dealio, what's this person 'gonna' get?

Right goes right into IVC (@ oblique angle) L enters L renal vein at 90 deg

Where do the R and L testicular vein go?

Fluid accumulation between the parietal and visceral layers of the tunica vaginalis.

Where is the fluid accumulation in the setting of a hydrocele?

LEFT SIDE (A) Left testicular vein has longer course (B) Left testicular vein has perpendicular insertion into the left renal vein, where as the right flows obliquely into the IVC. (C) The left renal vein (where the L testicular vein deposits) passes beneath the superior vesenteric artery creating a 'nutcracker' effect.

Which side is more susceptible to Varicocele and what are three reasons that this is the case?