Scrotum/Testicles

mediastinum testis

the structure that is formed by the tunica albuginea and contains the rete testis

Developmental weakness of the mesenteric attachment from the spermatic cord onto the testis and epididymis could lead to ____________________

torsion

The twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum is called __________________________.

torsion

Venous cuts off before Artery (true/false)

true

The tubuli recti or ____________connect the seminiferous tubule to the rete testis.

tubuli seminiferi recti

A remnant of the Wolffian Duct. It is a detached efferent duct.

Appendix Epididymis

The clinical presentation of the "blue dot sign"

Appendix Testis

Torsion of this appendage can occur in boys aged 7-12 yrs.

Appendix Testis

the contents of spermatic cord

Arteries: testicular artery, deferential artery, cremasteric artery. Nerves: nerve to cremaster muscle, testicular nerves. Duct: vas deferens. Veins: pampiniform plexus. Lymphatic vessels, and the lining around the testicles called the tunica vaginalis (originates from abdominal peritoneum).

Benign tumor of germ cell origin. Cyst is filled with white keratin.

Epidermoid Cysts

Hypoechoic, echogenic capsule or onion ring pattern (formed by multiple layers of keratin).

Epidermoid Cysts

Situated parallel to each testicle

Epididymis

May be seen sonographically as echogenic tissue deposit in the anterior or posterior aspect of the penis.

Peyronie's Disease

Occurs due to scar tissue (called plaque) that builds up in anterior or posterior aspect of penis.

Peyronie's Disease

The division of the two scrotal chambers is called the

SCROTAL RAPHE

Do not misdiagnose tubular ectasia as a _____________.

mass

Testes develop between the _________ and ___________ at the same time as the kidneys. As the fetus grows, the testes begin to descend into ________________.

posterior abdominal wall peritoneum the lower abdomen and pelvis.

May be caused by trauma - but often not known why. Associations include - plantar fasciitis, scleroderma, Behcet's syndrome, Sjogren's syndrome, Dupuytren's (trigger finger) - basically connective tissue and autoimmune disorders.

Peyronie's Disease

Painful. May be caused by blood getting trapped in the penis in what are called erection chambers.

Priapism

Some drugs may cause erection lasting more than 4 hours - examples include cocaine, marijuanan, mental illness/depression meds, and erectile dysfunction medication.

Priapism

results from an opening in the peritoneum that allows ascites to enter the scrotal sac.

congenital hydrocele

the body of the epididimis is also called

corpus

___________ - hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Usually occurs later in life due to thinner abd. walls

direct inguinal

Their___________________ in the presence of a testicular mass suggests testicular cancer, but can be associated with other conditions. (elavation/reduction)

elavation

Most common cause is STD's like Chlamydia Trachomatis and Neisseria Gonorrhea in men under 35 years of age could cause

epididymitis

the tail of the epididimis is also called

globus minor

he sudden appearance of a varicocele in an older man may be caused by

kidney tumor

Varicoceles usually occur on the left side 90%, most likely because the length of the ____________ testicular vein.

left

Trauma that could cause rupture of tunica albuginea also could lead to _________________.

orchiectomy

Tunica albuginea cysts may calcify and produce a posterior acoustic shadow. (true/false)

true

a sperm-filled cyst in the long, tightly coiled tube that lies above and behind each testicle.

spermatocele/epididymal cyst

palpable smooth, firm lump in the scrotum on top of the testicle.

spermatocele/epididymal cyst

The network of channels formed in the mediastinum of the testis.

RETE TESTES

By the ___________ month, the testes have usually moved through the inguinal canal into the scrotum. 8th-9th 7th-9th 6th-7th 6th-9th

7th-9th

The most common male genital birth defect

CRYPTORCHIDISM

How this disease called when penis that is bent when erect?

Peyronie's Disease

It is a rare anomaly commonly found on the left side and can be associated with undescended testis (cryptorchidism), torsion and malignancy.

Polyorchidism

Why the testes are located outside the body?

Sperm is best formed just below normal body temperature. Spermatogenesis is less efficient at lower and higher temperatures.

cord-like structure that passes into the inguinal canal to testis.

Spermatic Cord

_______________-hernia follows the pathway that the testicles made during fetal development. The hernia sac may protrude into the scrotum. May occur at any age.

indirect inguinal

If this does not occur, the sperm that enter the epididymis are not concentrated, resulting in ___________

infertility

Sonographically seen as an echogenic linear band extending longitudinally within the testis.

mediastinum testis

The combination of sperm and glandular fluid released by the urethra when a man ejaculates; normally a mixture of less than 1% sperm and 99% seminal fluid. What is that called?

semen

If Epididymitis not treated, may spread to involve testes causing swelling of the testis - will make it hypoechoic, hyperemia (hypervascular) - decreased arterial resistance (aka low resistance flow)

Epididymo orchitis

Treatment of Chronic Testicular Pain that cannot be defined as any structural abnormality by imaging modalities

Microsurgical Testicular Denervation

Appendix Testis is a remnant of the Mullerian Duct or Wolffian Duct?

Mullerian Duct

The septula forms wedge-shaped compartments that contain ____________.

the seminiferous tubules

Acute pain of testicle can be caused by

trauma, torsion, epididymitis/orchitis, thrombosed varicocele, appendix testis torsion, or incarcerated hernia.

Elevated B-hCG associated with both seminomas and nonseminomas but elevated serum alpha-fetoprotein is not found with seminomas, but is associated with nonseminomatous tumors. (true/false)

true

Elevated levels of alpha-fetoprotein or B-hCG correspond to the poor prognosis and METS. (true/false)

true

Tunica albuginea cysts range from 2 to 5 mm in diameter. (true/false)

true

Ultrasound is the 1st choice to find the peritoneal teste in the infant -followed by MRI or CT. (true/false)

true

Within 24-48 hours the pain usually disappears, indicating dead teste (true/false)

true

crotal pearls or benign scrotal macrolith may be the result of prior trauma or infection. (true/false)

true

The seminiferous tubules converge to form the _________.

tubuli recti

lab values (scrotum/testicles)

-Beta-human chorionic gonadotropin (B-hCG) -Alpha-fetoprotein (AFP)

Appendix Epididymis is a remnant of the Mullerian duct or Wolffian Duct?

Wolffian Duct

Formed in the Leydig cells of testes.

testasterone

The male sex glands also called

testes

Normal adult testes measurement

3-5cm (length) x 3 cm (AP) x 2-4 cm (width)

"BAG OF WORMS"

varicocele

a dilatation of the pampiniform venous plexus and the internal spermatic vein.

varicocele

acute torsion (time)

within 24 hours

Common condition that represents the deposition of multiple tiny calcifications throughout both testes.

Microlithiasis

Known associations of microlithiasis

-testicular germ cell tumor -cryptorchidism -testicular infarct -infertility -Down syndrome

2 Main Functions of Testes

1. CREATION OF SPERM 2. SECRETION OF ANDROGEN HORMONES- mostly TESTOSTERONE

About ____% of full-term and _____% of premature infant boys are born with at least one undescended testis

3% and 30%

Microlithiasis is in approximately ______% of GCT cases

50%

The first structure seen - in the near field (penis) sonographically?

Corpus Spongiosum

Having this pathology is 48 times more likely to develop cancer. May also contribute to infertility.

Cryptorchidism

Septum - also called________________ - is a layer of muscle fibers, lying beneath the scrotal skin and dividing the scrotum into two chambers.

Dartos

Likely to originate from the rete testis Normally located near the mediastinum testis

Intratesticular Cysts

The testicle is surrounded by a fibrous capsule, the tunica albuginea

MEDIASTINUM TESTIS

Indications for Ultrasound (scrotum) list (6)

PAIN- acute or chronic TRAUMA MASSES UNDESCENDED or ABSENT TESTICLE INFERTILITY CHANGES IN SIZE- larger or smaller

erection lasting more than 4 hours

Priapism

Location where the sperm are concentrated as fluid is reabsorbed.

RETE TESTES

Sac/pouch that protects the testes, blood vessels, and part of the spermatic cord.

Scrotum

A complication of epididymo orchitis which may lead to inflammation, fluid filled mass with areas of mixed echogenicity

Testicular Abscess

The Epididymis can be divided into three main regions:

The head (Globus Major) - Largest part of epi, sits adjacent to superior area of teste.The head of the epididymis receives sperm via the efferent ducts of the mediastinum of the testis. The body (Corpus) The sperm travel through body The tail (Globus Minor) This inferior area is involved in absorbing fluid to make the sperm more concentrated. It forms an acute angle and courses cephalad (curls up, look at diagrams) as it becomes the vas deferens (also known as the ductus deferens)

Benign condition involving numerous small, tubular cystic structures within the rete testis.

Tubular Ectasia

This condition is common in older men and involves numerous small, tubular cystic structures within the rete testis.

Tubular Ectasia

The layer of dense, whitish, fibrous connective tissue that surrounds the testis.

Tunica Albuginea Cysts

Chronic pain of testicles could be caused because of:

Vasectomy, Hernia surgery, Kidney removal, Scrotal or pelvic trauma, Recurrent epididymal/testicular infections, Nerve hyper-stimulation

undesended testes can be found:

abdominal, inguinal, prescrotal (prepubic)

Usually solitary, occasionally they may be multiple, and measure up to 1 cm in diameter, producing a discrete acoustic shadow.

calcifications or Scrotoliths (scrotal pearls)

calcified loose bodies within the membranes of the tunica vaginalis with no clinical importance.

calcifications or Scrotoliths (scrotal pearls)

Most common condition that causes acute scrotal pain.

epididymitis

Torsion symptoms could mimic ______________

epididymitis

Usually unilateral- may affect head, body or tail. Feels like a hard cord posterior to the testis. Could be caused by UTI's in prepubertal boys and men older than 35 years of age.

epididymitis

nlarged hypoechoic epididymis. Increased blood flow (hyperemia) Reactive hydrocele. Scrotal wall thickening. The infection may extend into the testicle causing orchitis.

epididymitis

Only 15% of intratesticular tumors are benign (true/false)

false. only 5%

the head of the epididymis is also called

globus major

The main symptom is a painless, swollen testicle, on one or both sides, which feels like a water-filled balloon

hydrocele

a collection of fluid inside the area of the scrotum, surrounding the testicle.

hydrocele

the most common cause of scrotal swelling

hydrocele

Epididymal knot also called

missed torsion

what it could be? These patients usually have a completely normal scrotal ultrasound, but has a chronic pain but cannot be defined as any structural abnormality by imaging modalities.

nerve hyper-stimulation along the spermatic cord nerve fibers

Elevated levels of LDH (Lactic Dehydrogenase) are associated with?

non-seminoma germ cell tumors (NSGCT).

testes function

produce sperm and testosterone

treated only when they cause pain or embarrassment, or when they decrease the blood supply to the penis (rare).

spermatocele/epididymal cyst