Scrotum

what is testicular blood flow supplied by?

1. deferential artery 2. cremasteric artery (external spermatic) 3. testicular artery

what are the 2 most common causes of scrotal pain?

1. epididymitis/orchitis 2. torsion of the spermatic cord

testicular torsion can be found in up to what percent of males?

12%

torsion most occurs in males age?

12-18

Testicular neoplasms are the most common solid tumor in men age??

15-35 years

What is the most common age range to see malignant testicular masses?

18-late 20's

in men under the age of 35, epididymitis is most commonly caused from?

STD

in men older than 35, epididymitis is usually caused from?

UTI

what is the epididymis composed of?

a head body and tail

what is the most common extra testicular tumor?

adenomatiod tumor

small projection off the epididymis

appendix epididymis

normal variant, a remnant of the mullein duct, small ovoid structure located beneath the head of the epididymis

appendix testes

how is the mediastinum testes seen on US?

as echogenic linear band extending longitudinally within the testes

a layer of muscle fibers that divide the scrotum into the 2 chambers, what causes the seperation

dartos

inflamation of the epididymis

epididymitis

most common acute scrotal condition that causes scrotal pain

epididymitis

what is the scrotum surrounded by?

fibrous capsule made up of the tunica vaginalis and tunica albuginea.

What kind of tumors account for 95% of testicular tumors?

germ cell tumors

in what part of the epididymis is a spermatocele most commonly found in?

head of epididymis

blood that fills scrotal sac, almost always associated with trauma

hematocele

what is the normal sonographic appearance of the scrotum?

homogenous medium level echo texture

serous fluid that accumulates between the layers of the tunica vaginalis

hydrocele

the division of the scrotum

scrotal raphe

formed by the separations into wedge shaped compartments

seminiferous tubules

what is the most common germ cell tumor?

seminoma

what kind of tumor has the most favorable prognosis of all testicular tumors?

seminoma

what usually causes an abscess?

severe epididymitis that starts and spreads to the testicle

what is torsion associated with?

skin thickening and hydrocele

what is the main symptom of a germ cell tumor?

something palpable

why are 90% of varicoceles on the left side?

the gonadal vein has to make a sharp turn and drain into the left renal vein

what is the positional relationship of the head of the epididymis and the scrotum?

the head is superior in long and runs on top

a saccular extension of the peritoneum into the scrotal chambers

tunica vaginalis

what increases the risk of a seminoma?

undescended testicles

most common non germ cell tumor in children and adults, usually benign

leydig cell -causes precocious puberty -produces testosterone

most intra-testicular masses are?

malignant

what does an abscess look like sonographically?

present with an enlarged testicle containing a predominantly fluid filled mass with hypo echoic areas or mixed echogenecities

the tubule recti enter the mediastinum testes forming a network of channels called the?

rete testes

what can be a precursor to testicular cancer and often seen in a testicle that has a mass?

scrotal calcifications

bowel or tissue protruding through the inguinal canal into the tunica vaginalis of the scrotum

scrotal hernia

what are the types of germ cell tumors?

-seminoma -embryonal cell -teratoma -choriocarcinoma -yolk sac tumor

what does the spermatic cord consist of?

-vas deferens -cremasteric, deferential, and testicular arteries -pampinoform plexus of veins -lymphatics -nerves

what percent of germ cell tumors are choriocarcinoma?

1-3%

survival rate for embryonal cell germ cell tumor

30-35%

Teratoma makes up what percent of germ cell tumors?

4-10%

at what age is leydig cell tumor most common?

4-5

after how many hours after a torsion does the testicle salvage rate decrease?

6-8 hours after 12 it is 0%

what percent of tumors have 1 histologic type?

65%

what is the survival rate for a seminoma?

75-80%

congenital non attachment, testicle can rotate freely on spermatic cord

bell clapper deformity

most extra-testicular masses are?

benign

where are scrotal calcifications usually found?

between the layers of the tunica vaginalis

what is the most lethal and least common germ cell tumor?

choriocarcinoma

which germ cell tumor causes increased hCG in males?

choriocarcinoma

what is the most common mixed germ cell tumor?

combination of teratoma and embryonal cell carcinoma aka teratocarcinoma

hidden or undescended testicle

cryptochidism

what carries the seminal fluid from the rete testis to the epididymis?

efferent ductules

what is the positional relationship of the tail of the epididymis and the scrotum?

inferior in long and forms an acute angle and courses cephalad as the vas deferens

what are complications of cryptochidism?

infertility and cancer

where is cryptochidism most commonly found?

inguinal canal

A testicular infarct has what kind of appearance?

initially produces a focal or diffuse hypo echoic testicle but overtime testicle will decrease in size and become more hyperechoic in some areas

tunica albuginea is outer or inner?

inner

what are the 2 types of testicular cysts?

intratesticular cyst of tunica albuguinea

what does the epididymis look like sonographically?

isoechoic or slightly hyperechoic to the testicle

which side is a torsion more common on?

left

multiple septations arise from the tunica albuginea to form the?

mediastinum testes

Embryonal cell is most common in who and makes up what percent of germ cell tumors?

most common in pediatric and young adults and makes up 15-35% of germ cell tumors

where do intratesticular cysts normally originate?

near the mediastinum testes

when the testicle is brought down into the scrotal sac surgically

orchioplexy

inflammation of the testicle

orchitis

tunica vaginalis is outer or inner?

outer

cystic mass of the epididymis that results from dilatation of the epididymal tube

spermatocele

what is the most common scrotal mass?

spermatocele

Which germ cell tumor can be benign in children and is more likely malignant in adults?

teratoma

what are spermatoceles filled with?

thick milky fluid containing spermatozoa

what most commonly causes a testicular infarct?

torsion or trauma

seminiferous tubules converge to form the?

tubuli recti

how can inguinal hernias be visualized sonographically?

valsalva maneuver

abnormal dilated of the veins that drain the testicle

varicocele

what is the most common correctable cause of male infertility?

varicocele

what carries the sperm out of the testicle?

vas deferens

what will cause a varicocele to dilate?

when a patient stands, val salvas or with abdominal compression

what germ cell tumor is associated with increased AFP?

yolk sac

what is the most common germ cell tumor in infancy typically less than 2 years of age?

yolk sac