Small Parts Midterm
PT, PTT, and platelet count are required ______ most procedures
before
(more _____) Teratoma - embryonal cell carcinoma
benign
Pleomorphic adenoma
benign and most frequent tumor of the salivary glands; most commonly seen in the parotid gland; hypoechoic mass
Adenoma
benign thyroid neoplasm characterized by complete fibrous encapsulation
Sialadenosis
benign, painless enlargement of the salivary gland; usually affects both parotid glands; enlarged gland without hypervascularity
Biopsies should be taken in various portions of the mass to confirm
colloid or abnormal cells
Ascites drainage is a ________ sonography request
common
Goiter
enlargement of the hyperplastic thyroid gland that can be focal or diffuse; multiple nodules may be present
The role of the cytopathogy team is to ensure
enough diagnostic tissue is obtained; increase the percentage of successful biopsies; minimize the number of core samples; possibly reduces overall procedure time
nocturia
excessive urination at night
the superior thyroid artery is the 1st branch of the
external carotid artery
PTT (partial thromoplastin time) can be used to evaluate
factors found in the intrinsic and common pathways
Hydrocele
fluid formed between the visceral and parietal layers of the tunica vaginalis
Epididymal cyst
composed of clear fluid whereas spermatoceles are filled with thick milky fluid containing spermatozoa. Both lesions result from prior episodes of epididymitis.
Peripheral zone
comprises the posterior, lateral, and apical aspects of the prostate. The peripheral zone is the most common site for prostate cancer. It accounts for 70% of the prostate
Thyroglossal duct cysts
congenital anomalies that present in midline of the neck anterior to the trachea, superior to the thyroid gland and near the hyoid bone
The thyroid gland is ______ to the thyroid cartilage and larynx
inferior
apex
inferior region of the prostate
Sialadenitis
inflammation of a salivary gland - heterogeneous, hyperemic, visibly enlarged, and may contain diffuse hypoechoic regions
orchitis
inflammation of a testicle
Epididymitis
inflammation of the epididymis
Epididymo-orchitis
inflammation of the epididymis and testis
prostatitis
inflammation of the prostate
Thyroiditis
inflammation of the thyroid
The most common location of the cryptorchid testis is in the _______. Less than 10%of undescended testis are located in the abdomen.
inguinal canal or prescrotal positions
tunica albuginea
inner fibrous membrane surrounding the testicle
these arteries have corresponding thyroid veins that drains into the
internal juglar vein
Signs of malignancy in intratesticular masses include
irregular shape of the testis and the appearance of normal parenchyma around the mass. The presence of a large hydrocele is uncommon in malignancy and usually indicates a benign condition. Small hydroceles are a common feature of testicular cancer. The presence of a swollen epididymis or scrotal wall swelling in combination with a testicular mass is suggestive of orchitis rather than tumor. Color or power Doppler may show disorganized hyperemic blood flow around a malignant tumor. However, small tumors (<1.5 cm) may not demonstrate typical tumor vascularity
verumontanum
junction of the ejaculatory ducts with the urethra
Serum calcium
laboratory value that is elevated with hyperparathyroidism
Sternocleidomastoid muscles
large superficial muscles anterolateral to the thyroid and strap muscles
the common carotid artery and the internal jugular vein are _______ to the thyroid gland
lateral
In renal biopsies, the _______ is preferred, as it offers a safer approach than the right. Typically, the lower pole is biopsied because it lies more posterior than the other poles.
left kidney
Typically, the ________ patient position is used in a prostate biopsy
left lateral decubitus
The _____ is the most common organ biopsied for either specific areas or masses or for diffuse parenchymal disease.
liver
normal measurements
lobes: 4-6cm length, 2-3cm width, 1-2 cm height isthmus: 2cm length, 2cm width, 2-6mm
extrathyroidal parathyroid adenoma
located posterior and echogenic line of separation from the normal thyroid gland
hypotension
low blood pressure
Hypophosphatasia
low phosphatase level, which can be seen with hyperparathyroidism
Spectral Doppler can be used to differentiate arterial from venous flow and to characterize arterial resistance. Doppler waveforms obtained from the capsular and intratesticular arteries show
low-resistance profiles characterized by high end-diastolic flow velocities. The resistive index (RI) and pulsatility index (PI) measurements obtained from these arteries show low values indicative of the low resistance to blood flow. Waveform analysis of the arteries within the spermatic cord may show either low-or high-resistance patterns as the vessels are intertwined. The testicular artery demonstrates a low-resistance waveform, whereas the cremasteric and deferential arteries will show high-resistance waveforms (very little diastolic flow with high RI and PI values)
Seminoma spreads initially to draining ______ in the retroperitoneum. When an intratesticular mass is discovered, paraaortic region should be evaluated for lymph nodes
lymph nodes
testicle
male gonad that produces hormones that induce masculine features and spermatozoa
The common indication for a biopsy is to confirm a _________ in a mass
malignancy
All intratesticular masses should be considered potentially _____ until proven otherwise.
malignant
yolk sac tumor - choriocarcinomas (more_______)
malignant
punctate
marked with dots
Calcifications ("Scrotal Pearls")
may be located within the testicle or between the layers of the tunica vaginalis
Platelete count
measures the number of platelets in blood sample.
The esophagus is located posterior and _____ to the left lobe of the thyroid
medial
The left of the thyroid is _____ to the left CCA and IJV
medial
The right lobe of the thyroid is ____ to the right CCA and IJV
medial
Metastatic disease to the testis is most commonly from
melanoma, lung, kidney, and prostate cancer
septa testis
multiple septa formed from the tunica albuginea that course toward the mediastinum testis and separate the testicle into lobules
Inguinal canal
normal passageway in the lower anterior abdominal wall that allows foe the passage of the spermatic cord into the scrotum
normal parathyroid glands are ____ generally seen on sonography
not
Follicular carcinoma
occurs as a solitary malignant mass within the thyroid gland
chorionic villus sampling
sampling of placental tissues for prenatal diagnosis of potential genetic defects
thyroid inferno
the sonographic appearance of hypervascularity demonstrated with color Doppler imaging of the thyroid gland
mediastinum testis
the structure that is formed by the tunica albuginea and contains the rete testis
median raphe
the structure that separates the scrotum into two compartments externally
Answer Appendix epididymis
the testicular appendage located at the head of the epididymis
Appendix vas
the testicular appendage located between the body and tail of the epididymis
Appendix testis
the testicular appendage located between the head of the epididymis and the superior pole of the testis
the inferior thyroid artery is a branch of the _______ of the subclavian artery
thyrocervical trunk
Blood tests to measure TSH, T4, T3 and Free T4 are readily available and widely used to assess _________
thyroid function.
Microcalcifications
tiny echogenic foci within a nodule that may or may not shadow
Subacute (de Quervain's) thyroiditis
viral infection of the thyroid that causes inflammation
Longus colli muscle
wedge-shaped muscle posterior to the thyroid lobes and CCA, on the anterior surface of the vertebral column
tunica vaginalis
membrane consisting of a visceral layer (adherent to the testis) and a parietal layer (adherent to the scrotum) lining the inner wall of the scrotum; a potential space between these layers is where hydroceles may develop
Papillary carcinoma
most common form of thyroid malignancy
Mucoepidermoid carcinoma
most common malignancy of the salivary glands; typically starts in the parotid gland; hypoechoic or heterogeneous mass with moderate to marked internal vascularity
Describe anapestic carcinoma
- highly malignant and grows rapidly - typically a disease of the elderly
normal thyroid parenchyma sonographic appearance
- homogenous - consist of medium - to high-level echogenicity. That is greater than the strap muscles and similar to testes
Men with elevated _____ levels or palpable nodules found on a rectal digital examination may be referred for a prostate biopsy
PSA
4 main types of thyroid cancer
Papillary carcinoma Follicular carcinoma Medullary carcinoma Anaplastic carcinoma
_______ is sometimes helpful in identifying abnormalities of the parathyroid glands
Parathyroid MIBI scan (Nuclear Medicine)
Ejaculatory ducts
connect the seminal vesicle and the vas deferens to the urethra at the verumontanum
Hyperthyroidism
TSH decreases; T3/T4 increases
Hypothyroidism
TSH increases; T3/T4 decreases
hematocele
contains blood and would therefore be more likely to be associated with trauma. Because of the blood cells within it, a hematocele will show low-level echoes with ultrasound
spermatocele
cyst of the vas deferens that contains sperm
Spermatoceles
cystic masses of the epididymis that result from dilatation of the epididymal tubules; more common than epididymal cysts; usually occur at the epididymal head.
Hypovolemia
decreased blood volume
Nodular hyperplasia
degenerative nodules within the thyroid
Stensen duct
the main duct of the parotid gland
Digital rectal examination
the medical procedure that requires the insertion of the finger into the rectum to palpate the prostate gland and lower gastrointestinal tract
testicular vein
the pampiniform plexus forms each testicular vein; the right testicular vein drains directly into the inferior vena cava, whereas the left testicular vein drains into the left renal vein
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates a "time-out" before any procedure. A "time-out" includes
the patient reciting her or his full name, and the patient's identification number is confirmed along with the type and location of the procedure
Hematospermia
the presence of blood within the semen
biopsy
the removal of living tissue from the body for diagnostic examination
The scrotal wall thickness ranges between ______, great than ____ mm is considered as abnormal.
- 2 and 8 mm - 10
Describe follicular carcinoma
- 2nd most common type of thyroid cancer - occurs later in life, especially in women -spreads via bloodstream rather than through nodes, so distant metastases to the bone, lungs, brain, and liver are more likely than metastasis to cervical lymph nodes
The size of the Testis. Adult testicles measure ____ cm in length, ____ cm in width, and __ cm in thickness
- 3 to 5 - 2 to 4 - 3
The wait time for discontinuing aspirin is __________ ; for heparin, ________ is the wait time; and for Coumadin, the wait time is ________.
- 5 to 7 days - 4 to 6 days - 3 to 4 days
It is a true surgical emergency in which time is of the essence. Salvage rates range from 80% to 100% if the patient is treated within __ hours of symptom onset. After this time, the salvage rates drop considerably. The testicle is usually not salvageable after __ hours.
- 6 - 24
What is tunica albuginea?
- A dense, fibrous connective tissue membrane completely surround the testis - Is surrounded by the parietal layer of the tunica vaginalis. - It converges at the posterior surface of the testis and is reflected interiorly as a vertical septum known as the mediastinum testis. - Inserts int the posterior aspect of the testicle, where the efferent ductulus and blood vessels enter to form a vertical septum called the mediastinum - is a peritoneal sac that lines the inner walls of the scrotum, covering each testis and epididymis
Describe the sonographic findings of a varicocele
- A group of anechoic, tubular structures located outside of the testis - Distended veins that fill with color flow when the Valsalva maneuver or with abdominal compression is performed - Dilated veins that measure greater than 2 mm - Possibly associated with hydronephrosis, hepatomegaly, or a retroperitoneal neoplasm if found on the right - B-Mode imaging usually displays most varicoceles. Improved visualization can be achieved by performance of the Valsalva maneuver or scanning the patient in an upright position. Color or power Doppler is very helpful in delineating the dilated veins and differentiating varicocele from other anechoic extratesticular structures.
Describe the clinical findings of epididymitis and epididymo-orchitis
- Acute epididymis is the most common condition that causes acute scrotal pain. - Acute testicular pain - Leukocytosis - Fever - Dysuria - Urethral discharge - Scrotal wall edema - Pyuria
Describe the clinical findings of acute testicular torsion
- Acute onset of testicular pain (often during sleep), sudden onset - Possible pain within the lower abdomen and inguinal region - Swollen testis/scrotum - Nausea and vomiting - Leads to venous occlusion and arterial ischemia causing infarction of the testicle. Torsion more often involves the left testicle.
Describe the clinical findings of Hashimoto thyroiditis
- Autoimmune thyroid disease - typically occurs as a painless, diffuse enlargement of the thyroid in young or middle-aged woman - common cause of hypothyroidism - depression - increased cold sensitivity - elevated blood cholesterol levels - slight weight gain may occur - puffy face and puffiness under the eyes
The number of the gauge corresponds to the diameter of the needle: the _______ the number, the _____ the diameter
- higher - smaller
What is vas deferens?
- Beginning with the body and ending at the tail of the epididymis, the vas deferens is formed from these structures - The vas deferens ascends medially and cephala and carries semen - The vas deferens continues cephalad until reaching an ampulla just proximal to the prostate and adjacent to the seminal vesicles
Describe the sonographic findings of a pyocele
- Complex fluid collection within the scrotum - Scrotal wall thickening - May be seen in conjunction with rupture of a testicular abscess
Describe the sonographic findings of a testicular abscess
- Complex intratesticular mass - An enlarged testicle containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas - Mass that has no flow centrally but increased flow around its margins - May have a coexisiting pyocele
Describe the risk factors of seminoma
- Cryptorchidism (undescended testicles) - Family history of testicular cancer - Infertility - Klinefelter syndrome (XXY) - Down syndrome - Smoking - white race
What is scrotum?
- Cutaneous, fibromuscular sac - Divided internally into two sacs by median raphe - Each contains a single testis
Describe the sonographic findings of epididymitis and epididymo-orchitis
- Enlargement of the entire epididymis (diffuse) - Enlargement of only part of the epididymis (focal) - Hypoechoic echotexture of the affected section(s) of the epididymis - Hypoechoic testis (with orchitis) - Hyperemia within the epididymis and/or testis - Thickened scrotal wall - Reactive hydrocele - This infection may extend into the testicle causing orchitis. Sonographically, orchitis is seen as an enlarged and hypoechoic testicle with increased blood flow - Color Doppler is an essential tool in the evaluation of testicular torsion and epididymo-orchitis. It does not add any pertinent information in evaluation of testicular microlithiasis.
Describe the sonographic findings of acute testicular torsion
- Enlargement of the spermatic cord, epididymis, and testis - Thickened scrotal wall - Hypoechoic or heterogeneous testis - Reactive hydrocele - No intratesticular flow - Decreased intratesticular flow (as compared to the asymptomatic testis
Describe the sonographic findings of an inguinal hernia
- Heterogeneous mass within the scrotum that moves (peristalsis) - Mass may contain air and fluid - Hydrocele may be present - The presence of peristalsis confirms the diagnosis. - Small inguinal hernias can be visualized by using the Valsalva maneuver
Describe the laboratory values related to serum tumor markers
- High levels of serum AFP is more suggestive non-seminomas - Serum beta-hCG is seen in both seminomas and non-seminomas - Beta-human chorionic gonadotropin - Alpha-fetoprotein
Describe papillary carcinoma
- Most common thyroid cancer - represents most thyroid cancer (75%-90% of thyroid cancers) and is the least aggressive - has a good prognosis if treated early - is often multifocal with cervical lymph node metastases present early in the course of the disease - the presence of nodal metastasis in the neck does not adversely alter the prognosis
Describe the clinical findings of a testicular abscess
- Painful, swollen scrotum - Fever - Leukocytosis - Usually a complication of epididymo-orchitis
Describe the clinical findings of a seminoma
- Painless scrotal mass - Hardening of the testis - Elevated hCG
Describe the sonographic findings of scrotal trauma
- Possible fracture line - Indistinct testicular margins - Hematocele
_________ lymph nodes are usually suspicious for cancer as opposed to _____ nodes with echogenic centers from a fatty hilum
- Round, homogeneous - oval
Describe the sonographic findings of a hydrocele
- Simple anechoic fluid anterior to the testis without internal septations - Scrotal wall thickening - Chronic hydroceles may have internal debris and septations - Low-level echoes from fibrin or cholesterol crystals may be visualized within the hydrocele - A small hydrocele may be present with malignancy, but large hydroceles are most commonly associated with inflammation such as orchitis and epididymitis. Neither a varicocele or epididymal cyst is associated with hydrocele formation
Describe the sonographic findings of a seminoma
- Solid, predominantly hypoechoic well-demarcated and sometimes multifocal intratesticular mass - A homogeneous echo texture is usually present - Large seminomas may become heterogenous, may show bright areas due to internal hemorrhage
List the testicular cancer staging
- Stage I tumor confined to the testicle They are very radiosensitive,and stage 1 seminomas have a high cure rate (95-100%). - Stage II tumor spread to lymph node - Stage III tumor spread to lungs, brain, liver
Describe the blood supply to the scrotum
- The blood supply to the scrotum is derived from three vessels - the testicular, deferential, and cremasteric arteries. - The testicular artery arises from the abdominal aorta just below the level of the renal artery on each side. - It courses through the spermatic cord to the mediastinum testis where it branches into capsular arteries. - The capsular arteries give origin to the centripetal arteries that course through the testicular parenchyma toward the mediastinum. - Near the mediastinum, the centripetal arteries branch into the recurrent rami (centrifugal arteries), which travel in the opposite direction. - The vas deferens and epididymis receive blood from the deferential artery, which is a branch of the vesical artery. - The peritesticular tissue is supplied by the cremasteric artery, which is a branch of the inferior epigastric artery
What is epididymis?
- The efferent ducts empty into the epididymis - The epididymis lies along the posterolateral aspect of the testis and is made up of a head, body, and tail - Its size is 6-7 cm in length, 0.6-1.5 cm in width, and it contains more than 6 meters of coiled tubul
Describe the drainage of blood from the scrotum
- The testicle is drained by a network of veins that arise from the mediastinum to form the pampiniform plexus converges into three veins, the testicular, the deferential, and the cremasteric vein - The right testicular vein drains directly into the inferior vena cava and the left drains into the left renal vein
What is testes/testicles (plural) testis (single) including size, shape?
- The testis is an ovoid shaped male reproductive gland measuring approximately 4*3*3 cm. - It is divided into more than 250 conical lobules containing the seminiferous tubules. - These tubules converge at the apex of each lobule as the tubuli recti. - The rete testis is formed by the anastomosis of these tubules in the mediastinum. - It is connected to the head of the epididymis throughout the efferent ducts.
Describe the clinical findings of a hydrocele
- Transilluminates light - Painless scrotal swelling - May present with pain when found in the presence of scrotal infections, testicular torsion, trauma, or a tumor - May be congenital or acquired - May be idiopathic
Describe the clinical findings of scrotal trauma
- Trauma to the scrotum resulting in acute scrotal pain - Low hematocrit
Describe the clinical findings of a Varicocele
- Typically, painless (large varicoceles can cause discomfort) - Palpable extratesticular mass - Possible infertility - 90% of the varicoceles are on the left side. This is due to the length of the left testicular vein as it drains into the left renal vein - Unilateral scrotal pain may be associated with varicocele thrombosis
Color Doppler plays a very important role in ultrasound evaluation of the scrotum. Color Doppler equipment should demonstrate adequate sensitivity to detect intratesticular flow in all normal patients. Describe how to get optimal color Doppler?
- Use of low pulse repetition frequency (PRF) and low wall filter settings. - Increasing the packet size (number of sound pulses per line) improves sensitivity to flow by improving the signal-to-noise ratio. - Use of high Doppler frequencies improves demonstration of slow flow but decreases penetration. - Color gain should be maximized to the background noise limit to improve visibility of the small intratesticular vessels.
Laboratory tests which measure the time it takes the blood to form a clot should be reviewed before most procedures, test results should be obtained as close to the date of the procedure as possible. This is especially true for patients on blood thinners such as what three drugs?
- Warfarin (Coumadin) - heparin - aspirin
thyroid cysts
- account for 20% of all cold lesions on nuclear medicine studies - true thyroid cysts are rare - typically benign - usually results from hemorrhage or cystic degeneration of an adenoma
Describe sonographic findings of a thyroglossal duct cyst
- anechoic - well defined - unilocular cyst with posterior enhancement - may have internal components - cystic midline mass typically seen in adolescents associated with an upper respiratory infection - cystic dilation of thyroglossal duct which is a remnant of the thyroid gland migration from the pharyngeal epithelium
Describe sonographic findings of a brachial cleft cyst
- anechoic mass near the angle of the mandible - are a remnant of embryonic development - may be connected to the mouth and become infected - solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the mandible under the sternocleidomastoid muscle
Describe the location of thyroid gland
- anterior portion of the neck - right and left lobes drape laterally over the larynx - isthmus is located anterior to the larynx
Describe the clinical findings of Grave's disease
- autoimmune disorder - most common cause of hyperthyroidism - bulging eyes (exophthalmos) - heat intolerance - nervousness - weight loss - hair loss - rapid heart rate - muscle atrophy
Most extratesticular masses are _____, but the majority of intratesticular lesions are _____.
- benign - malignant
Describe the sonographic findings of Hashimoto thyroiditis
- diffuse enlargement of the thyroid gland - heterogenous echotexture - multiple, ill-defined hypoechoic regions separated by fibrous hyperechoic tissue - hypervascularity gland
Some abnormal values that may trigger a request for a biopsy or aspiration include
- elevated alpha-fetoprotein (AFP) in the presence of a liver lesion - elevated prostate-specific antigen (PSA) to evaluate for prostate cancer - changes in thyroglobulin levels in a patient with a history of thyroid cancer - increased white blood cell count (leukocytosis) when an abscess is suspected - hematuria along with a renal mass.
primary hyperparathyroidism
- elevated serum calcium - elevated PTH
Describe the sonographic findings of Grave's disease
- enlarged gland - heterogenous or diffusely hypoechoic echotexture - thyroid inferno - hypervascularity is noted with color flow doppler - presence of thyroid-stimulating immunoglobulins (TSI) is diagnostic of Grave's disease
Describe the sonographic findings of a goiter
- enlarged thyroid gland - diffusely heterogeneous echotexture - multiple nodules with cystic and solid components
Describe sonographic findings of abnormal lymph nodes
- enlargement of the node >1 cm - rounded shape - loss of the echogenic hilum - calcifications - may be hyperemic or demonstrate abnormal vascular patterns with color doppler - normal lymph nodes are less than 1-1.5 cm in size, elliptical in shape.
Describe benign characteristics of thyroid nodules
- extensive cystic components - cyst <5mm - hyperechoic mass - eggshell calcifications - hot nodule
describe malignant characteristics of thyroid nodules
- hypoechoic mass - taller than wide shape - mass with internal micro calcifications (psammoma bodies) - solitary mass - marked vascularity within the central part of the nodule - interrupted peripheral calcification - extra capsular invasion - lobulated margins - enlargement of the cervical lymph nodes (metastasis) - cold nodule - mass is firm and nontender
There are multiple reasons that lead to an inconclusive result, including
- insufficient material - necrotic lesion - not biopsying the area of malignancy
most common ectopic location include
- intra-thyroid - mediastinum - near carotid bifurcation
Describe medullary carcinoma
- is uncommon - typically exhibits microcalcifications - typically secretes the hormone calcitonin which can be useful serum marker - associated with multiple endocrine neoplasia syndrome
Describe the clinical findings of an inguinal hernia
- may consist of intestine or omentum - Results in from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum - Persistent or intermittent scrotal swelling - May have abdominal pain and blood in stool
Describe the clinical findings of a goiter
- palpable enlarged thyroid gland - dyspnea - dysphagia - feelings of tightening on the throat - coughing - hoarseness
Describe clinical findings of abnormal lymph nodes
- palpable neck mass - enlarged nodes may be painful - causes of enlarged lymph nodes include local infection, mononucleosis. metastatic disease
parathyroid glands are
- round/oval - hypoechoic structures normally less than 0.5 cm in size
what are the adenomas
- typically found in elderly women - can be multiple and contain functioning thyroid tissue - a hyperechoic, hypoechoic, or isoechoic mass with a hypoechoic halo is typical finding
Testicular torsion occurs more often during adolescence, between
12 - 18 years of age
Fine-needle aspiration (FNA), or cytologic aspirarion, uses thin-gauge needles to obtain cells form within the mass. FNA is performed using a ________ needle, preferably with a cutting tip, such as a Franseen, Chiba, or spinal needle
20- to 25-gauge
There are ____ parathyroid glands
4, 2 on each side of the thyroid
Germ cell tumors comprise _____ of all testicular tumors. The most common germ cell tumor is seminoma (40-50%).
93-95%
Describe the sonographic appearance of the normal testis.
A homogeneous medium-level echo texture.
Hypercalcemia
An excessive amount of calcium in the blood; associated with hyperparathyroidism
____ or congenital absence is rare and accounts for only 4% of patients who present with cryptorchidism
Anorchia
testicular artery
Artery arising from the aorta just distal to each renal artery; it divides into two major branches, supplying the testis medially and laterally
bengin prostatic hypertrophy
BPH, enlargement of the prostate gland, Causes: old age, when prostate gland enlarged begins to block urine flow, Signs: painful urination, frequent urination, noturia, Treatment: meds, surgery, therapy, TURP,
Exophthalmos
Bulging of the eyeballs, associated with hyperthyroidism
_____ are typically used to image an abdominal testis, although imaging posterior to a filled bladder may aid in the abdominal evaluation by ultrasound
CT and MRI
_____ may on occasion be helpful, but ultrasound is by far the preferred modality to assess the thyroid, parathyroid and cervical lymph nodes
CT and MRI
________ responsible for removing calcium from the blood for storage in the bones
Calcitonin
Nutcracker syndrome
Compression of left renal vein between SMA and aorta
Klinefelter Syndrome (XXY)
Extra X chromosome is present in male causing: - infertility - small testicles - gynecomastia - long legs - abnormal low intelligence
How to evaluate the thyroid masses?
Fine needle aspiration (FNA) is the most effective method for diagnosing malignancy in a thyroid nodule
__________ are the most common testicular cancers. They are classified as either seminoma or nonseminoma, based on their histology.
Germ cell tumors
A standard method was developed called the ____________ because of the variability of PT results among laboratories
INR (international normalized ratio)
________ are complications of cryptorchidism. Patients with cryptorchidism have an increased risk of developing a malignancy in both the undescended testis and the contralateral testis.
Infertility and cancer
What is the tunica vaginalis
It is composed of two layers, parietal visceral. The parietal layer is the inner lining of the scrotal wall. The visceral layer covers the testis and epididymis. The space between these two layers of the tunica vaginalis normally contains a small amount of fluid. Hydroceles form in this space. A bare area exists where the tunica vaginalis does not cover the posterior aspect of the testis.
Testicles are usually descended at birth, although spontaneous descent may occur in the first year. _______ is the treatment of choice and is usually performed on patients aged 2-10 years.
Orchiopexy
The benefit of Power Doppler in the evaluation of the scrotum
Power Doppler is beneficial in the evaluation of the scrotum. Because aliasing is not displayed with power Doppler, the PRF can be reduced to improve sensitivity without detrimental effect. Additionally, the absence of aliasing results in excellent demonstration of testicular arterial anatomy.
What is primary malignancy?
Primary tumor in a patient with an undiagnosed malignancy (The original cancer site)
Percutaneous Umbilical Blood Sampling (PUBS)
Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis.
hepatorenal syndrome
Progressive renal failure associated with hepatic failure characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity
______ biopsies are requested on patients with proteinuria, nephrotic syndrome, and renal failure
Renal
De Quervain Syndrome
Subacute thyroiditis secondary to a viral infection
___________ will appear as multiple echogenic foci with no acoustic shadowing within the testis. These tiny calcifications have been associated with malignancies, infertility, Klinefelter syndrome and cryptorchidism
Testicular microlithiasis
Describe the sonographic appearance of the normal epididymis?
The epididymis is normally isoechogenic or slightly more echogenic than the testis
Myxedema
The most severe form of hypothyroidism, characterized by swelling of the hands face and feet. May lead to coma and death
What is the meaning of low resistance within the testicular parenchyma?
The normal arterial waveform within the testicular parenchyma is described as low resistance. This means that there is forward flow throughout the cardiac cycle without cessation at any point.
Paracentesis
The removal of fluid from a body cavity via a needle, a trocar, a cannula, or another hollow instrument
What does the spermatic cord consist of
The spermatic cord consists of the testicular, cremasteric, and deferential arteries as well as the vas deferens, lymphatics, nerves of the testis, and a pampiniform plexus of veins
________ biopsies can be helpful in distinguishing malignant masses from goiters or adenomas.
Thyroid
__________________ aids in the metabolism of fats, proteins, and carbohydrates
Thyroxin (T4) and Triiodothyronine (T3)
3 thyroid hormones
Thyroxine (T4) Triiodothyronine (T3) Calcitonin
The most common correctable cause of male infertility
Varicocele
Describe the causes, complications, diagnose of varicocele.
Varicocele are dilated veins of the pampiniform plexus. Most occur due to incompetent valves of the testicular vein. Other etiologies include renal vein thrombus or tumor extension on the left side. Varicoceles have been shown to be associated with infertility. They are much more common on the left than the right. Veins larger than 2 mm in the supine position or 2.5mm in the standing position are considered to be abnormal. It is best to over diagnose rather than under diagnose varicoceles in the fertility so as not to misdiagnose a potentially treatable cause of infertility.
Psammoma bodies (microcalcofication)
round, punctate calcific deposit
In general, inflammation almost anywhere in the body increases the vascularity seen with color Doppler
With torsion, no flow is present within the testicle, orchitis is inflammation of the testicle, so hyperemic flow is apparent with color Doppler. No flow is seen within a hydrocele, although color signals due to particle streaming of the hydrocele fluid may be detected. Blood flow id absent in areas of infarction, and therefore no color Doppler signal is detected
Hematocele
a collection of blood located between the visceral and parietal layers of the tunica vaginalis
Epididymal cyst
a cyst located anywhere along the length of the epididymis;cyst filled with clear, serous fluid located in the epididymis
Thyroid-stimulating hormone (TSH)
a hormone secreted by the pituitary gland that stimulates the thyroid gland to secrete thyroxine and triiodothyronine
Parathyroid hormone (PTH)
a hormone that is secreted by the parathyroid glands, which regulate serum calcium levels
Secondary malignancy?
a metastatic mass in a patient
pyramidal lobe
a normal variant extending superior to the isthmus; Agnes's of a lobe may also occur
scintigraphy (thyroid)
a procedure to image the thyroid gland. 99m-Tc pertechenetate is the radiopharmaceucal administered intravenously and imaged on a gamma camera.
hysteroscopy (HYS)
a procedure to look at the inside of a uterus. this procedure is commonly used to diagnose bleeding problems in women, remove polyps or fibroids or perform other procedures
prostate-specific antigen (PSA)
a protein produced by the prostate gland
Chlamydia
a sexually transmitted disease that can lead to infection of the genitals
Calcitonin
a thyroid hormone that is important for maintaining a dense, strong bone matrix and regulating the blood calcium leve
Germ cell tumor
a type of neoplasm derived from germ cells of the gonads; may be found outside of the reproductive tract
Cryptorchidism
also called undescended testes; testicles remain within the abdomen or groin and fail to descend into the scrotal sac the condition of having an undescended testis or testicles; is associated with infertility and an increase in the risk for malignancy in the involved testis; most often found just above the scrotum or within the inguinal canal
Sjogren's syndrome
an autoimmune disease that a%ects all glands that produce moisture; leads to dysfunction of the salivary glands and severe dryness of the eyes, nose, skin, and mouth
Cremasteric muscle
an extension of the internal oblique muscle that descends to the testis with the spermatic cord; contraction of the cremasteric muscle shortens the spermatic cord and elevates the testis
Epididymis
anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single, convoluted epididymal tubule; located on the posterolateral aspect of the testis; the epididymis consists of the head, the body, and the tail; spermatozoa mature and accumulate within the epididymis
Sonographically both lesions appear identical
anechoic, well-defined masses with no or few internal echoes
The isthmus of the thyroid gland is _____ to the trachea
anterior
The strap muscles are located _____ to the thyroid
anterior
The sternocleidomastoid muscles (SCM) are located ______ to the thyroid
anterolateral
Testicular microlithiasis
are frequently seen sonographically. Microlithiasis has not been proven to define a benign or malignant testicular condition
Intratesticular cyst
are normally located near the mediastinum testis and probably originally from the rete testis.
Deferential artery
arises from the vesicle artery (a branch of the internal iliac artery) and supplies the vas deferens and epididymis
The needle tip should appear
as an echogenic dot
Graves' disease
autoimmune disorder characterized by a diffuse toxic goiter, exophthalmos (bulging eyes), and cutaneous manifestations, the most common cause of hyperthyroidism
A core biopsy, utilizes an automated, spring-loaded devices, termed a ______. It provides tissue for histologic analysis. The throw length is the distance that the needle will advance when fired.
biopsy gun
fine needle aspiration (FNA)
biopsy technique that uses a narrow hollow needle to obtain tiny amounts of tissue for pathologic examination
pleural effusion
build-up of excess fluid between the layers of the pleura outside the lungs
corpora amylacea
calcifications in inner gland of prostate
parathyroid glands secrete parathyroid hormone, which regulates
calcium and phosphorus metabolism
Hashimoto's thyroiditis
chronic inflammation of the thyroid gland caused by the formaon of antibodies against normal thyroid issue; a progressive autoimmune inflammatory disorder of the thyroid gland; most common cause of hypothyroidism
scrotum
sac containing the testes and epididymis
thermal ablation
destruction of tissue by extreme hyperthermia or hypothermia.
he cytopathologist looks at the slides to determine if the material is
diagnostic
dyspnea
difficulty breathing
Dysphagia
difficulty swallowing
variocele
dilated veins in the pampiniform plexus caused by obstruction of the venous return from the testicles
Hyperparathyroidism
disorder associated with elevated serum calcium level, usually caused by a benign parathyroid adenoma; may lead to osteoporosis and nephrolithiasis
Lymphadenopathy
disorder characterized by localized or generalized enlargement of the lymph nodes or lymph vessels
Parathyroid hyperplasia
enlargement of multiple parathyroid glands
Secondary hyperparathyroidism
enlargement of parathyroid glands in patients with renal failure or vitamin D deficiency
Two methods in performing ultrasound-guided procedures
free-hand techniques and the use of needle guides
Idiopathic
from an unknown origin
Bulbourethral gland
gland that secretes pre-ejaculate fluid that lubricates the penile urethra prior to ejaculation; also referred to as the Cowper gland
Strap muscles
group of three muscles (sternothyroid, sternohyoid, and omohyoid) that lie anterior and lateral to the thyroid
Bell-clapper deformity
he condition in which the patient lacks the normal posterior fixation of the testis and epididymis to the scrotal wall; classically bilateral
Specific complications of a renal biopsy include
hematuria and a perinephric hematoma
PTT (partial thromoplastin time) can be used to evaluate the effects of
heparin, aspirin, and antihistamines on the blood-clotting process.
Human chorionic gonadotropin
hormone produced by the trophoblastic cells of the early placenta; may also be used as a in nongravid patient and males
most common manifestation of multiple endocrine neoplasia (MEN type 1) resulting in
hyperplasia of all four parathyroid glands (secondary hyperparathyroidism)
Most malignant testicular neoplasms are ______ compared to the normal testicular parenchyma
hypoechoic
the pituitary gland is regulated by the
hypothalamus
Medullary carcinoma
neoplastic growth that accounts for 10% of thyroid malignancies
Multinodular goiter
nodular enlargement of the thyroid associated with hyperthyroidism
secondary hyperparathyroidism
occurs in patients with chronic renal failure, the inability of kidneys to filter results in increased amounts of serum phosphates - all 4 parathyroid glands enlarge - elevated serum phosphates - serum calcium decreases
Hyperthyroidism
over secretion of thyroid hormones, associated with Graves' disease
Primary hyperparathyroidism
oversecretion of parathyroid hormone, usually from a parathyroid adenoma
Most ______ mass biopsies are performed to confirm the diagnosis of adenocarcinoma, unresectable adenocarcinoma, or pancreatitis in patients with unusual imaging findings
pancreatic
_______ most common cause of enlargement of a parathyroid gland
parathyroid adenoma
the inability to synthesize vitamin D depresses the serum calcium level which stimulates
parathyroid gland hyperplasia
High blood calcium levels and high blood parathyroid hormone (PTH) are indicative of ________
parathyroid tumor
The preprocedural image should document the
patient's name and the time, date, and demonstration of the needle path.
thyroid stimulating hormones (TSH) is produced by the _______ to stimulate the thyroid to produce thyroid hormone
pituitary
Reverse Trendelenburg position
places the body supine on an incline but with the head now being elevated
Pampinifiorm plexus
plexus of veins in the spermatic cord that drain into the right and left testicular veins; when a varicocele is present, dilation and tortousity may develop
Sialolithiasis
salivary duct stones; most commonly located within the submandibular gland; dilated duct containing a shadowing, echogenic focus or foci
Central zone
portion of the prostate that surrounds the urethra and encases the ejaculatory ducts. It is located at the prostatic base. It is typically the site of BPH but is rarely affected by prostate cancer. Accounts for 20% to 25% of the prostate glandular tissue
The longus colli muscle (LCM) are _____ to the thyroid
posterior
parathyroid glands are located
posterior surface to the thyroid gland
Complications from an ultrasound-guided biopsy are usually minor and may include
postprocedural pain or discomfort, vasovagal reactions, and hematomas. Serious complications, although rare, include bleeding, hemorrhage, pneumothorax pancreatitis, biliary leakage, peritonitis, infection, and possibly death
pyramidal lobe
present in a small percentage of patients; normal variant, extends superiorly from the isthmus
Inguinal hernia
protrusion of a loop of the intestine through layers of the abdominal wall in the inguinal region
Anaplastic carcinoma -
rare, undifferentiated carcinoma occurring in middle age
Euthyroid
refers to a normal functioning thyroid gland
Branchial cleft cyst
remnant of embryonic development that appears as a cyst in the neck; benign congenital neck cysts found most often near the angle of the madible
thyriodectomy
removal of the thyroid gland
seminal vesicles
reservoirs for sperm located posterior to the bladder
The ______ is the most common malignant neoplasm of the testicles; is a germ cell tumor that typically found in males between 30 and 50 years of age; found in patients suffering from cryptorchidism; most unilateral; seminomas are radiosensitive and chemosensitive resulting in the most favorable prognosis of all testicular tumors.
seminoma
Gonorrhea
sexually transmitted disease that leads to infection of the genitals
Common cause of epididymitis in younger men (under 35 years of age) are the
sexually transmitted diseases chlamydia and gonorrhea
Cremasteric artery
small artery arising from the inferior epigastric artery (a branch of the external iliac artery), which supplies the peritesticular tissue, including the cremasteric muscle
Epidermoid cyst
small benign mass within the testicle that contains keratin
The sonographer should look for _____ in a thyroid mass; a higher percentage of positive cells are observed
small calcifications
Urethra
small membraneous canal that extends from the bladder to the end of the penis
Isthmus
small piece of thyroid tissue that connects the right and left lobes of the gland
Extratesticular cysts
spermatocele, epididymal cyst, and tunica albuginea cyst
TNM classification
staging technique for prostate cancer. "T" refers to tumor size, "N" refers to lymph node involvement, and "M" refers to the presence of metastasis.
Hands free technique
standardise handling of sharp instruments during surgery; decreasing the risk of occupational exposure.
spermatic cord
structure made up of vas deferens, testicular artery, cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum
The thyroid gland is ____ to the clavicles
superior
base
superior region of the prostate
orchiopexy
surgery of an undescended testis in the scrotum
Transurethral Resection of the Prostate (TURP) - surgical procedure most often used to treat men with BPH. A portion of the prostate is removed by a cystoscope to relieve pressure on the urethra
surgical procedure most often used to treat men with BPH. A portion of the prostate is removed by a cystoscope to relieve pressure on the urethra
Thoracentesis
surgical puncture of the chest wall for removal of fluids; usually done by using a large-bore needle
paracentesis
surgical puncture to remove fluid from the peritoneal cavity.
recurrent rami
terminal ends of the centripetal arteries that curve backward toward the capsule
Centripetal artery
terminal intratesticular artery arising from the capsular arteries
Prothrombim Time (PT)
test to evaluate blood clotting. Protein produced by the liver.
Blue dot sign
the appearance of a torsed testicular appendage that can be observed as a blue dot just under the skin surface
Trendelenburg position
the body is laid supine, or flat on the back on a 15-30 degree incline with the feet elevated above the head.
Ascites
the build up of fluid in the space between the lining of the abdomen and abdominal organs
Wharton duct
the duct that drains the submandibular gland
PT (prothrombin time) is used to evaluate factors found in
the extrinsic pathway
Colloid
the fluid produced by the thyroid that contains proteins and thyroid hormones
Hot nodules
the hyperfunctioning thyroid nodules seen on a nuclear medicine study that are almost always benign
Cold nodules
the hypofunconing thyroid nodules seen on a nuclear medicine study that have malignant potential
Pudendal artery
the internal and external pudendal arteries partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis
Intrathyroidal parathyroid adenoma
the lack of echogenic line of separation. - surrounded by normal tissue
vas deferens
tube that connects epididymis to the seminal vesicle
transitional zone
two small glandular areas located on either side of the proximal urethra. Comprises approximately 5% of the gland. It cannot be distinguished from the central zone by ultrasound
There are still a small percentage of lesions that cannot be seen by ultrasound. These are typically
typically isoechoic lesions, especially in the liver.
Hypothyroidism
under secretion of thyroid hormones
In a renal transplant procedure, the ________ of a transplant kidney is biopsied to avoid possible lacerations of the main renal vessels and ureter
upper pole
The patient with a thoracentesis should be scanned in the same position that the procedure will be performed, which is usually _______
upright (sitting)
Common cause of epididymitis in men older than 35 years old
urinary tract infection
Fine-needle aspiration
use of a fine-gauge needle to obtain cells from a mass
cordocentesis
usually done after 18 weeks of pregnancy, can be used to detect certain genetic discord's, blood conditions and infections. It can also be used to deliver blood and medication to the fetus via umbilical cord
pyocele
will also show low-level echoes form pus resulting from infection.