Scrotal pathology images

torsion

- 4 to 5 hours, testis become swollen and hypoechoic. lobes easy to visualize bc of adema - more than 24 hours become heterogeneous bc of hemorrhage, infarction, necrosis, vascular congestion

rupture

- focal alteration of pacrenchymal pattern -interruption of the tunica albuginea -irregular contour -scrotal wall thickening -hematocele

Hematoma associated with trauma

- large, can displace testis. -heterogeneous -can be cystic - no color flow

Microlithiasis

- under 3 mm -bilateral -associated with testicular malignancy -associated with crytoorchidism, klinefelter's syndrome, infertility, vericocele, atrophy, male pseudoherm.

Anorchia

-Absence of one or both testicles -Unilateral caused by torsion or other decreased vascular supply -have a male XY genotype. scrotal sac empty with micropenis

Leukemia

-Next most coomon secondary test neoplasm, found in children

Severe case of orchitis

-Testicular infarction may occur -tesis confined within a rigid tunica albuginea -Color Doppler shows decreased or absent flow, waveforms will have high resistance with little or no diastolic flow. -Doppler waveform showing reversed distasolic flow indictaes testicular infarction

vericocele

-abnormal dilation of veins of pampiniform plexus -Primary more common on the left (left renal vein= nutcracker) -Secondary caused by increased pressure on spermatic vein: hydonephrosis, masses, cirrhosis -seen in infertile men

intratesticular varicocele

-appearance of channels coursing from the mediastinum into the testicular tissue. -Identify with color doppler

Microlithiasis

-bright non shadowing foci abnormal=more than 5 on a single image

Pyocele

-collection of pus -untreated infections or abscess ruptures into the space between the layers of the tunica vaginalis

Hematocele

-collections of blood -trauma, surgery, neoplasms, torsion

Hydrocele

-contain serous fluid -most common cause of painless swelling -may follow trauma or with neoplasm -more common -Associated with torsion or epidid-orchitis

Germ cell tumor

-elevated hcg and afp -95% of all test tumors are germ cell and highly malignant

Epididymitis

-epididymis enlarged and hypoechoic -If hemorrhage, then focal hyperechoic areas -Increased blood flow, increased velocities -testes normal if infection not spread

Epididymo-Orchitis

-epididymis the primary organ involved -infection can spread to testes (orchitis secondary to epididymitis) -fever, urethral discharge

Hydrocele

-fluid filled collection outside anterolateral aspect of testis -anechoic or low level echoes -infection will have more internal echoes or septation

pyoceles and hematoceles

-indistinguishable on u/s -both contain internal echoes, thickened septations, loculations -air indicates abscess

Epididymo-Orchitis

-infection of the epididymis and testis -result of lower UTI that spread -Most common cause of acute scrotal pain in ADULTS -can be caused by: mumps, syphilis, tb, viruses, trauma, chemical

Sperm granuloma

-inflammatory reaction to leakage of spermatozoa -seen with history of vasectomy -u/s determines if mass is intra or extratesticular

vericocele

-measure greater than 2 mm. Increases with valsalva-check -retroperitoneum for mass

Cyst

-men over 40 -associated with extratesticular spermatocele -near mediastinum

Malignant testicular masses

-most common malignancy in men 15-35 -undescended testes 2.5-8 times more likely to develop cancer. -painless lump, enlargment, discomfort -obtain patient hx or differentiate hematoma, orchitis, abscess, infarctions, sperm granuloma

Seminoma

-most common type of testicular tumor, composed of immature germ cells -hypoechoic, smooth well defined borders

Lymphoma

-most comnmon bilateral secondary test neoplasm in men over 60

Scrotal hernia

-occurs when bowel, omentum, or other structures herniate into scrotum. -Bowel peristalsis -omental will appear echogenic because of omental fat

Metastasis

-rare, later in life -Primary sites: prostate, kidneys, lung, pancreas, bladder, colon, thyroid, melanoma -bilateral

Epididymitis:

-scrotal wall thickening and hydroceles -complex hydroceles=severe epididymitis and orchitis. Has thick septations and low-level echoes

Tubular ectasia of the rete testis

-uncommon, benign - Greater than 45 y/o -not seen unless abnormal -hypoechoic prominent channe;ls near echogenic mediastinum testis -avascular

Cryptoorchidism

-undescended testicles -may be in inguinal canal (palpable), abdomen -more common in premie babies -orchioplexy to implant into the scrotum

Polyorchidism

-very rare -more common in left side -found in scrotum or inguinal canal or retroperitoneum -absent efferent spermatic system

Sperm granuloma

-well defined solid mass -hypo or isoechoic to epidid -heterogeneous -increased color if inflamed

torsion

-whirlpool sign -enlarged epipdidymal head -scrotal skin thickening -hydrocele

Most common cause of torsion (anomaly)

Bell clapper deformity

__ masses are usually benign and __ masses are more lilely malignant

Extratesticular; intratesticular

In sever cases of epididymitis:

Pyocele may be present: internal septations loculations debris

Cysts located in the extratesticular structures:

epididymal cysts, tunica albuginea cysts, spermatoceles

Spermatoceles always occur in the __ of the epidid

head

Hydrocele, pyocele, or hematocele will develop where

space between the visceral layer and parietal layers of the tunica vaginalis.

How to distinguish between epididymal tumor and sperm granuloma:

sperm granulomas painful, epidid tumors are not. History of vasectomy points to sperm granuloma

Most common cause of pain in YOUNG ADULTS

torsion (occurs all ages but avg is 14)

How to differentiate between tubular ectasia and intratesticular vericocele:

tubular ectasia of the rete testis will not show color.

differentiating torsion and epididymo-orchitis:

use Color Doppler