Ch 13. and 14
causes of tendonitis
repeated wrist extension or palmar flexion
within mediastinum
rete testis
3 layers of breast tissue
pre-mammary (subcutaneous) mammary (parenchymal, glandular) retromammary
retroperitoneal inferior to bladder between symphysis pubis and rectum
prostate
what scrotal abnormality is caused by incompetent valves within the pampiniform plexus
varicocele
creates ejaculatory duct
vas defrens and seminal vesicles
most likely tumor to metastasize to subcutaneous fat
melanoma
intratesticular mets from
melanoma, lung, kidney, prostate
inflammation of the breast that is related to pregnancy is referred to as
puerperal mastitis
site for benign prostatic hyperplasia
transitional zone
symptoms of hematocele
trauma, recent surgery, decreased hematocrit
testicular torsion is associated with
trauma, strenuous exercise, sexual activity, bell clapper deformity
dilated veins of a varicocele will measure
>2mm
oval shape
CC
what tests can be performed to determine a torn Achilles tendon
Thompson test
sono appearance of complete tendon rupture
anechoic, hetero, hematoma, refractive shadowing
tunica albuginea
beneath TV, forms mediastinum
which of the following houses the male urethra
corpus spongiosum
along length of epi
epididymal cysts
all of the following are sonographic findings consistent with the diagnosis of testicular torsion except
hyperemic flow within the testis
sono appearance of prostate cancer
hypo variable hypervascular
sono appearance of cryptorchidism
hypo to normal testis
sono appearance of hemangioma
hypoechoic blood flow
connect bone to bone
ligaments
partial dislocation
subluxation
normal testis thickness
3 cm
sex cord stromal tumors of the testicles
Leydig cell tumor. Sertoli cell tumor.
sono appearance of vascular impotence
cavernosa artery diastolic flow does not decrease
base of prostate
central zone
a 23 year old man presents to the sonography Department with the history of infertility which of the following is associated with male infertility
varicocele
symptoms of varicocele
-dull ache along spermatic cord -scrotal pain or heaviness
sono appearance of lipoma
1. Oval and well defined 2. Isochoic(although hyperechoic and hypoechoic lesions are seen) 3. Homogeneous 4. Compressible 5. Usually superficial 6. May be mistaken for a fat lobule
sono appearance of epi head
10-12 mm, isoechoic or echogenic
common ages for testicular torsion
12-18 years
normal testis width
2-4 cm
normal wall thickness of scrotum
20 mm
normal testis length
3-5 cm
common age for joint effusion
5-10 years
enlargement of the prostate in older men is often caused by
BPH
PSA elevated with
BPH cancer prostatis infarcts
surrounded by bucks fascia
CC CS
elliptical, medium level echoes
CS
barlow test
Detection of unstabloe hip by adduction and extension of hip. The "feel" of dislocation is felt as femur leaves acetabulum
symptoms of mastitis
Firm, red, swollen, tender breast w/ fever, myalgias, chills, malaise
Zinner syndrome
Renal agenesis Ipsilateral seminal vesicle cyst Obstruction of ejaculatory duct perineal pain, recurrent prostatitis, painful ejac, infertility
zinner syndrome consists of unilateral renal agenesis ejaculatory duct obstruction and
Seminal vesicle cysts
periphery of testicle, within the TA
TA cysts
symptoms of epididymitis
WBC, fever, dysuria, urethral discharge, edema
which of the following best describes a spermatocele
a cyst found within the head of the epididymis that may contain debris
all of the following are true of ganglion cyst except
a ganglion cyst is a common mass found along the superior aspect of the hand and wrist between the tarsals
orlanti test
abducting, lifting thigh
Most commonly injured ankle tendon
achilles
symptoms of testicular torsion
acute pain, often during sleep, pain in lower abd/inguinal are, swelling, nausea, vomiting, higher positioned testis
symptoms of appendix testis torsion
acute, localized pain to superior pole, blue dot sign
which of the following would most likely resemble a solid intra testicular mass and be associated with Cushing syndrome
adrenal rest
most common times for gynecomastia
after birth puberty 50-80 years old
which of the following at the sight of a forward body may produce bright echoes and therefore cause some ambiguity about the correct orientation of the object
air
sono appearance of seminal vesicle cyst
anechoic complex
sono appearance of bakers cyst
anechoic mass, posterior enhancement, echogenic fluid, debris, pannus, septations
sono appearance of transient synovitis
anechoic, hypo fluid that elevated anterior capsule on joint
sono appearance of epidermal cysts
anechoic/hypoechoic, complex/hyperechoic
most common cause of acute scrotal pain in prepubital boys
appendix testis torsion
symptoms of bakers cyst
asymp focal tenderness
extratesticular masses are assumed
benign
the most common location of a hydrocele is
between the 2 layers of the tunica vaginalis
sono appearance of adrenal rests
bilateral round hypoechoic, intratesticular mass near mediastinum
symptoms of prostate cancer
blood in urine/semen, back/pelvic/hip/thigh pain, impotence, decreased fluid
associated with DDIH
breech babies, oligo, female infants spina bifida, arthrogryposis
dense fibrous tissue
bucks fascia
second largest prostatic zone
central zone
bullet shrapnel and other metallic objects may cause
comet tail artifact
sono appearance of a pyocele
complex fluid collection with scrotum, WT, rupture of abscess
sono appearance of hematocele
complex fluid collection within scrotum, wall thickening
sono appearance of testicular abscess
complex intratesticular mass, no central flow, increased peripheral flow, pyocele
sono appearance of breast abscess
complex, focal mass with debris
sono appearance of pilonidal cyst
complex, subcutaneous mass, hyperemia, hypoechoic tract from cyst to skin surface
inner penis tissue
corpus spongiosum paired corpus cavernosa
undescended testes
cryptorchidism
clinical findings of a Baker system I mimic those of a
deep vein thrombosis
causes of vascular impotence
diabetic neuropathy
tunica vaginalis
double-layered membrane covers each testis and separates it from scrotal wall
sono appearance of ligament
echogenic
tendon sonographically appear as
echogenic fibrous structures connecting muscles to bone
sono appearance of mediastinum
echogenic linear in sag triangular in trans
sono appearance of tendons
echogenic, fibrous structures
symptoms of pilonidal cyst
edema, warmth, pain, bloody drainage
gynecomastia associated with
elevated hcg, testicular/adrenal tumors, elevated estrogen, hepatblastoma, klinefelters, drugs
elevated AFP
embryonal cell carcinoma, teratoma, yolk sac tumors
what kind of gland is the testes
endocrine and exocrine
sono appearance of epididymitis
enlarged epi, hypoechoic epi/testes, hyperemia, WT reactive hydrocele
sono appearance of prostatitis
enlarged, hypoechoic, hyperemeia
sono appearance of BPH
enlargement of inner gland, hypoechoic areas, calcs, diffusely hetero, cystic changes
sono appearance of epi after vasectomy
enlargement, cystic areas
sono appearance of acute testicular torsion
enlargements of spermatic cord, epi, testis WT, hypo/hetero testis, reactive hydrocele, no blood flow
which of the following is a benign intra testicular mass that typically has a world or onion skins on a graphic appearance
epidermoid cyst
most common cause of acute scrotal pain in adults
epididymitis
sono appearance of scrotal pearl
extremely echogenic, mobile, extratesticular structure, shadowing
hypoechoic, rounded structure, echogenic stripes
femoral head
symptoms of testicular abscess
fever, WBC, painful, swelling
sono appearance of partial tendon rupture
focal hypoechioc area
milk filled cyst
galactocele
sono appearance of varicocele
group of anechoic tubular structures located outside of testis, distended veins, fill with color
benign enlargement of breast
gynecomastia
sono appearance of DDH
head completely or partially outside of acetabulum small alpha angle large beta angle
symptoms of prostatitis
hematospermia, painful ejac., perineal pain, dysuria
sono appearance of inguinal hernia
hetero mass in scrotum, moves, may contain air, fluid, hydrocele
sono appearance of yolk sac tumors
hetero mass with areas of hemorrhage and calcs
sono appearance of choriocarcinoma
hetero mass with areas of hemorrhage, necrosis, calcs
sono appearance of embryonal cell carcinoma
hetero mass with cystic components
sono appearance of muscles
hypoechoic contain linear echogenic structure
sono appearance of gynecomastia
hypoechoic mass posterior to areola, triangular shaped
which of the following best describes the most common sonographic appearance of gynecomastia
hypoechoic retro areolar mass
sonographically normal muscle appears as
hypoechoic tissue that contains linear, echogenic strands
sono appearance of subcutaneous skin
hypoechoic with interspersed hyper linear echoes
sono appearance of retromammary layer
hypoechoic, contains fat
sono appearance of cellulitis
hypoechoic, edematous strands within soft tissue, cobblestone appearance
sono appearance of seminal vesicles
hypoechoic, enlarged, low level echoes, anechoic when fluid filled
hyperemic flow within or around a structure is often indicative of
inflammation
multiple, small along mediastinum
intratesticular cysts
most common form of testicular torsion
intravaginal
shape of prostate
inverted pyramid base superior apex inferior
sono appearance of penile trauma
irregular hypo/hyper defect at site of rupture
clinical findings of tendonitis include all of the following except
itching in the area of the tendon
A6 year old female patient presents to the sonography Department for a hip sonogram with irritability unwillingness to walk and low grade fever sonographically visualize a hypoechoic fluid collection that elevates the joint capsule what is the most likely diagnosis
joint effusion
the most common location of a varicocele is the
left side of the scrotum
secondary varicocele's are most likely associated with all of the following except left sided location right sided location hepatomegaly renal mass
left sided location
symptoms of transient synovitis
leg/knee pain reluctance to walk, irritability, low grade fever, WBCs
sono appearance of focal tendonitis
localized, enlarged hypo
elevated HCG
malignancy
all of the following are sonographic findings consistent with torsion of the testicular appendage except
no intra testicular flow
symptoms of BPH
nocturia, increased frequency, sense of frequency, constant feeling of full bladder
sono appearance of ganglion cysts
noncompressible, anechoic mass acoustic enhancement, debris/septs
sono appearance of appendix testis torsion
normal blood flo, small, avascular hyper/hypo mass adjacent to superior pole, reactive hydrocele, WT
you have been asked to perform a study to rule out cryptorchidsim which means
one or both of the testicles have not descended into the scrotum
symptoms of cryptorchidism
one or both testes not palpable in scrotum
symptoms of tendon rupture
pain, edema, audible snap
Symptoms of tendonitis
pain, swelling, warm to touch
symptoms of cellulitis
pain, tenderness, swelling, warmth
symptoms of seminoma
painless mass, hardening
symptoms of teratoma
palp elevated AFP and HCG when malignant
symptoms of spermatocele
palp when large, no pain
symptoms of embryonal cell carcinoma
palpable elevated AFP, HCG
symptoms of yolk sac tumors
palpable elevated AFP
Symptoms of choriocarcinoma
palpable elevated HCG
subluxation denotes
partial hip dislocation
largest prostatic zone
peripheral zone
most common site for malignancy
peripheral zone
posterior later, apical gland
peripheral zone
the most common location of prostatic cancer is the
peripheral zone
embedded in the muscle of proximal urethera
periurethral glandular zone
smallest prostatic zone
periurethral glandular zone
symptoms of an inguinal hernia
persistent/intermittent swelling, abd pain, blood in stool
a patient presents to the sonography Department for a penile sonogram he complains of a painful curvature of the penis and impotence what is the most likely diagnosis
peyronie disease
build up of fibrous plaque and calcs
peyronnie disease
found in natal cleft
pilonidal cyst
primary varicoceles are associated with all of the following except left sided location retroperitoneal mass infertility Palpable extra testicular mass
retroperitoneal mass
sono appearance of extratesticular cysts
round, anechoic mass, acoustic enhancement, may have layering debris
sono appearance of galactocele
round, complex mass, fluid-fluid level
sono appearance of mastitis
rule out abscess ill defined areas of echogenicity with diffuse edema, hypoechoic fluid, >2 mm WT, enlarged lymph nodes
common areas for epidermal cysts
scalp, face, neck, trunk, back
from vas defrens to
seminal vesicles
paried, superior to prostate, posterior to bladder
seminal vesicles
converge at rete testis
seminferous tubules
spermatogenesis occurs within the
seminiferous tubules
the most common germ cell tumor of the testis is the
seminoma
what are germ cell tumors of the testicles
seminoma teratoma embryonal cells carcinoma yolk sac tumor choriocarcinoma
sono appearance of hydrocele
simple fluid anterior to testes, WT, debris/septations with chronis
sono appearance of seminoma
solid hypoechoic intratesticular mass, large-hetero
sono appearance of mets
solid, vascular, hypoechoic mass
most common scrotal mass
spermatocele
causes of epididymitis
spread of bacteria form UT or prostate trauma, chlamydia, gonorrhea
a standoff pad is most often useful in imaging
superficial structures
orchipexy
surgical transfer of an imperfectly descended testicle into the scrotum and suturing it there
corpus cavernosa
surrounded by TA, dorsal
corpus spongiosum
surrounds the urethra ventral
symptoms of gynecomastia
tender palp retroaerola mass firm to touch
connect muscle to bone
tendons
fluid within the synovial sheath is indicative of
tendosynovitis
inflammation of the tendon in synovial tendon sheath is referred to as
tendosynovitis
acute onset of testicular pain at rest is a common clinical finding with
testicular torsion
the endocrine function of the testicles is to produce
testosterone
which of the following best describes the Thompson test part 2
the calf squeeze in the foot should plantarflex in a patient who does not have a complete tear of the Achilles tendon
all of the following will aid in sonographic assessment of an Achilles tendon except
the patient is scanned standing with a small amount of pressure placed on the symptomatic side
which of the following best describes the Thompson test
the patient lies prone while the symptomatic calf is squeezed
which of the following is true about patients with a lipoma
they feel no pain in the area of the mass
sono appearance of diffuse tendonitis
thickened, hypoechoic
sono appearance of peyronnie disease
thickening TA, calcs
A 7 year old boy presents to the emergency room with testicular pain localized to the superior pole of his right testis what is most likely diagnosis
torsion of the testicular appendage
the blue dot sign is indicative of
torsion of the testicular appendage
most common cause of painful hip and joint effusion in children
transient synovitis
what is the most likely cause of a hip joint effusion in infants
transient synovitis
which of the following techniques is used for providing sonographic evidence of a varicocele
valsalva
symptoms of epidermal cysts
visible, palp mass just under skin, pain, redness
echogenic linear structure, extending from head acoustic shadow
ilium
sono appearance of scrotal trauma
possible fracture line, indistinct margins, hematocele
cryptorchidism is associated with
infertility, increased risk for malignancy
what lab value can be assessed as a tumor marker to evaluate a patient for testicular malignancy
AFP
is cystic mass located within the popliteal fossa is most likely a
Baker cyst
the accumulation of synovial fluid from a weakening in the joint capsule of the knee as seen in conditions as rheumatoid arthritis can result in a
Baker cyst
the lack of normal fixation of the testis to the posterior scrotal wall is referred to as
Bell Clapper deformity
inflammation and infection of the skin and subcutaneous tissue is termed
Cellulitis
superficial lipomas may appear as all of the following except hypoechoic isoechoic hyperechoic anechoic
anechoic
Which of the following is not a component of the spermatic cord epididymis testicular artery cremaster muscle lymph nodes
epididymis
stores sperm and transports it from the testes to vas defrens
epididymis
which of the following techniques is used to measure the relationship of the femoral head and acetabulum by evaluating the Alpha and beta angles
graf
the Achilles tendon connects the
heel to the calf muscle
which of the following would best describe a benign tumor composed of blood vessels
hemangioma
which of the following transducers would be best suited to sonographically assessed for a splinter in a patient's hand
high frequency linear array transducer
a simple fluid collection surrounding the testis is referred to as a
hydrocele
which of the following is consistent with the sonographic features of testicular Abscess
hyperemic flow around the Abscess but not within it
what would be the most likely sonographic appearance of a seminoma
hypoechoic
which of the following would best describe a benign tumor comprised of fat
lipoma
which of the following is a clinical test for developmental hip dysplasia that is used to evaluate the hip for reduction or relocation of a dislocated hip
ortolani
a patient presents with a palpable oozing mass at the level of the Natal cleft what is the most likely etiology of this mass
pilonidal cyst
Where are the seminal vesicles located?
posterior to the urinary bladder superior to prostate
in what position should the patient be placed to better evaluate the Achilles tendon
prone
acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector is referred to as
refractive shadowing
what is the most common malignancy of the testicles
seminoma
the exocrine function of the testicles is to produce
sperm
a common cyst most often seen in the head of the epididymis that contains nonviable sperm is the
spermatocele
what is the most common malignancy of the penis
squamous cell carcinoma
a patient presents to the sonography Department with a history of Cellulitis on his abdomen the patient has fever edema and complaints of focal tenderness in a specific region affected by the Cellulitis sonographically you identify a localized complex collection of fluid what is the most likely diagnosis
superficial Abscess
the most common location of BPH is the
transitional zone
during a sonographic examination of the right testis you visualize multiple small cysts located along the mediastinal what is the most likely diagnosis
tubular ecstsia of the rete testis
a dilated group of veins found within the scrotum is called a
varicocele
what is the most common correctable cause of male infertility
varicocele
sono appearance of fascia
hyperechoic varying thickness
Symptoms of achilles tendon rupture
posterior ankle/leg pain, audible snap
symptoms of penile trauma
hx of audible pop during sex, subcutaneous bleeding
larger than normal amount of fluid between 2 layers of TV
hydrocele
sono appearance of most foreign bodies
hyperechoic
sono appearance of mammary tissue
hyperechoic contains ducts and glandular tissue
sono appearance of superficial abscess
hypoechoic, focal fluid collection, complex peripheral rim of hyperemia
sono appearance of primary melanoma
hypoechoic, increased vasc
sono appearance of subcutaneous tissue
hypoechoic, mostly fat
symptoms of peyronie disease
impotence, painful erections palp area of scar, marked curvature
symptoms of galactocele
palpable, near areola, can be painful if infected
venous drainage of the testicles is through the
pampiniform plexus
a complicated Baker cyst may contain a thin flap of tissue referred to as
pannus
what is the most common cancer found in men
prostate cancer
sono appearance of chronic testicular torsion
hyperemic flow around testis, hetero testis with areas of necrosis
types of varicocele
primary secondary
symptoms of ganglion cysts
palpable mass, painful
Inability to obtain or maintain an erection.
vascular impotence
a common mass found along the dorsal aspect of the hand and wrist is the
ganglion cyst
which of the following is also referred to as a Bible bump
ganglion cyst
dorsal aspect of hand and wrist
ganglion cysts
most intratesticular tumor are
germ cell origin other are sex-cord stromal, lymphoma, leukemia, mets
all of the following are keys to identifying foreign bodies with sonography accept
most foreign bodies appear hypoechoic
sono appearance of microlithiasis
multiple echogencs foci, no shadowing
symptoms of breast abscess
palpable painful lump
separates testes
median raphe
Symptoms of Hemangioma
asymptomatic red/purple mass
symptoms of lipoma
asymptomatic compressible mass
a partial tear of a tendon typically appears as
focal hypoechoic areas within the tendon
symptoms of DDH
asymmetric skin folds, leg length discrepancy, limited limb abduction
symptoms of seminal vesicle cyst
asymptomatic
associated with microlithiasis
malignancy, infertility, Klinefelter, cyrpto
intratesticular masses are assumed
malignant
sono appearance of teratoma
hetero with calcs, hair, teeth
symptoms of hydrocele
transilluminates light, painless swelling, pain with infection, torsion, trauma, tumor
on both sides of proximal urethra
transitional zone
second most common site of malginancy
transitional zone
