CHAPTER 13 - THE MALE PELVIS

pain localized to the superior pole of the testis, acute testicular pain

Torsion of the appendix testis is the most common cause of acute scrotal pain in prepubertal boys.

On both sides of the proximal urethra Site for benign prostatic hyperplasia 2nd most common site of malignancies

Transitional Zone

Squamous cell carcinoma

Most common malignancy of the penis?

Seminiferous tubules

Spermatogenesis occurs within the;

Adult testicles measures;

3-5 cm in length, 2-4 cm in width and 3 cm in thickness.

Varicocele

A 23 year old man presents to the sonography department with a history of infertility. What is associated with male infertility?

Torsion of the testicular appandage

A 7 year old boy presents to the ER with acute testicular pain localized to the superior pole of his right testis. What is the diagnosis?

Spermatocele

A common cyst most often seen in the head of the epididymis that contains non viable sperm is the;

Varicocele

A dilated group of veins found within the scrotum;

Peyronie disease

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 diagnosis?

Central Zone

Base of prostate. Second largest prostatic zone.

Sound OFF

Benign prostatic hypertrophy commonly located within the transitional zone.

Pure seminoma ( not mentioned on the chart ) -Teratoma (benign with malignant potential) - maybe palpable. Elevated AFP & hCG if malignant. Heterogenous with calcifications. Cartilagem bone, fibrosis may contain hair & teeth -Embryonal cell carcinoma -Malignant / maybe palpable / heterogeneous with cystic components. AFP & hCG -Yolk sac tumor - malignant / maybe palpable / heterogeneous, hemorrhage & calcifications.Elevated AFP Choriocarcinoma - malignant - maybe palpable - heterogenous mass w/ areas of hemorrhage, necrosis , calcifications. Burned-out germ cell tumor ( not mentioned on the chart )

Germ cell tumors of the testicles

Epididymis

Is not a component of the spermatic cord;

Epidermoid cyst

It's a benign intratesticular mass that typically has a whorled or onion skin sonographic appearance;

Posterior lateral, apical gland. Largest prostatic zone Most common site for malignancy

Peripheral Zone

Embedded in the muscle of the proximal urethra Smallest prostatic zone

Periurethral glandular zone

Right sided location Hepatomegaly Renal Mass

Secondary varicoceles are most likely associated with;

Leydig cell tumor Sertoli cell tumor

Sex cord-stromal tumors

Hyperemic flow around the abscess but not within

Sonographic features of testicular abscess;

Hypoechoic testis Reactive hydrocele Decreased intratesticular flow Hyperemic flow around the testis

Sonographic findings consistent with the diagnosis of testicular torsion;

Small hyperechoic mass adjacent to the testis Reactive hydrocele Scrotal wall thickening Normal flow

Sonographic findings consistent with torsion of the testicular appendage;

bell clapper deformity

The lack of normal fixation of the testis to the posterior scrotal wall is referred to as:

Seminoma

The most common germ cell tumor of the testis is the;

Transitional zone

The most common location of BPH is the;

Between the two layers of the tunica vaginalis

The most common location of a hydrocele is;

The left side of the scrotum

The most common location of a varicocele is;

Peripheral zone

The most common location of prostatic cancer is the;

10-12 mm insize.

The normal epididymis measures;

Sound OFF

The normal mediastinum testis can be seen in the SAG plane as an echogenic linear structure and in the trans plane as an echogenic triangle

2 - 8 cm

The scrotal wall thickness ranges between

median raphe.

The scrotum is externally divided at the midline into two compartments by a structure known as;

One or both sides of the testicles have not descended into the scrotum

The term cryptorchidism means;

The spermatic cord enters the scrotum through the inguinal canal. The testicles receive their blood supply by testicular arteries. Venous drainage is performed through the pampiniform plexus, which empties into the testicular veins. The RT testicular vein drains into the IVC, and the LT one drains into the left renal vein.

Vascular Anatomy of the Male Pelvis

Corpus spongiosum

What does house the male urethra?

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

What is spermatocele?

Prostate cancer

What is the most common cancer found in men?

Varicocele

What is the most common correctable cause of male infertility?

Alpha-Fetoprotein

What laboratory value can be assessed as a tumor marker to evaluate a patient for testicular malignancy;

Varicocele

What scrotal abnormality is caused by incompetent valves within the pampiniform plexus?

Hypoechoic

What would be the sonographic appearance of a seminoma?

Adrenal rest

What would most likely resemble a solid intratesticular mass and be associated with cushing syndrome;

Seminal vesicle cysts

Zinner syndrome consists of unilateral renal agenesis, ejaculatory duct obstruction and ?

Verumontanum

area / junction of the ejaculatory ducts with the urethra

Seminal Vesicle Cysts

associated with zinner syndrome perineal pain, recurrent prostatis, painful ejaculation and infertility.

tunica albuginea

beneath the layers of the tunica vaginalis, the testis is surrounded by a dense fibrous layer of tissue called;

prostate-specific antigen (PSA)

can be indicative of benign prostatic hypertrophy, prostatic cancer, prostatitis, prostatic infarcts.

tunica vaginalis

each testis is surrounded by a double layer of tissue called;

orchiopexy

fixation of an undescended testis in the scrotum

seminoma

germ cell tumor, malignant, most common neoplasm of the testicle. elevated hCG level. hardening of testis, painless scrotal mass.

Sound OFF

hCG and AFP are tumor markers for testicular malignancies. Elevated AFP is mostly associated with embryonal cell carcinoma, teratomas and yolk sac tumors.

Adrenal Rests

hx of congenital adrenal hyperplasia, elevated adrenocorticotropic hormone. bilateral, round, hypoechoic, intratesticular masses (most commonly near the mediastinum testis)

Spermetocele

most common scrotal mass, cyst found most often in the head of the epididymis. nonviable sperm, debris, fat and lymphocytes.

Sound OFF

multiple small cysts located align the mediastinum testis represent cystic dilation of the rete testis also referred to as tubular ectasia.

Extravaginal torsion

occurs in the neonatal period or in utero and is related to torsion of the spermatic cord within the inguinal canal.

Transitional Zone

on both sides of the proximal urethra. site for benign prostatic hyperplasia. second common site for malignancies.

Peripheral zone

posterior lateral, apical gland. largest prostatic zone, most common site for malignancy.

hepatic mass, hepatomegaly, right sided renal mass, hydronephrosis

secondary varicoceles may be associated with;

ejaculatory duct

seminal vesicles and vas deferens combine to create;

posterior to the male urinary bladder and above the prostate gland

seminal vesicles located;

seminiferous tubules

spermatogenesis occurs within the

ecchymosis

subcutaneous spot bleeding / bruise

blue dot sign

the appearance of a torsed testicular appendage that can be observed as a blue dot just under the skin surface

Sound OFF

the penis consists of two corpus cavernosa and one corpus spongiosum

tunica dartos

the structure that separates the scrotum into two separate compartments internally

rete testis; located within the mediastinum testis

tiny tubules converge into a structure called;

ductus deferens (vas deferens)

tube that connects the epididymis to the seminal vesicles.

cryptorchidism

undescended testicles

Testicular torsion (waking up during sleep from pain)

Acute onset of testicular pain at rest is a common clinical finding with;

Base of prostate 2nd largest prostatic zone

Central Zone

> 2 mm

Dilated veins of a varicocele will measure;

tubular ectasia of the rete testis

During a sonographic examination of the right testis, you visualize multiple cysts located along the mediastinum testis. What is the most likely diagnosis?

Benign prostatic hypertrophy

Enlargement of the prostate in older men is most often caused by;

Sound OFF

Head = superior to the upper pole of the testis Body = Posterior to the testicle Tail = inferior to the lower pole of the testis

Seminoma

Most common malignancy of the testicles;

cremaster muscle

Muscle that pulls the scrotum closer to the body in cold temperatures and relaxes to let the testicles be farther away from the body in warmer weather

on the left side

Primary varicoceles are most often found;

inferior to the urinary bladder, between the symphysis pubis and the rectum

Prostate gland locates;

Torsion of the testicular appendage

The blue dot sign is indicative;

Sound OFF

The bulbourethral gland, also referred to as Cowper gland, secretes pre-ejacular fluid that lubricates the penile urethra prior to ejaculation.

Periurethral glandular zone

embedded in the muscle of the proximal urethra. smallest prostatic zone.

pampiniform plexus

venous drainage is performed through;