Test 2: Scrotum, Prostate, Penis
hypoechoic, hyperechoic, or heterogeneous
What is the sonographic appearance of the prostate gland in patients with benign prostatic hypertrophy?
zones
When imaging or describing the glandular prostate, the best technique to describe the prostate is to use
centrally
Where does the cavernosal artery course within the corposa cavernosa?
fever
Which is NOT a common symptom associated with acute scrotal conditions in the videos?
Prostate biopsy is commonly done at known sites of anatomic weakness.
Which of the following statements regarding ultrasound-guided prostate biopsy is TRUE?
base
superior portion of the prostate gland
orchiopexy
surgical procedure done to fasten an undescended testicle into the scrotum or repair an acute testicular torsion
tubular ectasia of the rete testis
A patient presents for a scrotal sonogram with a history of vasectomy and scrotal discomfort. Multiple cystic structures are seen in both testes along the mediastinum testis. Color Doppler does not demonstrate any flow in these cystic structures.
epididymo-orchitis
A common cause of acute scrotal pain in adults is:
parietal and visceral layers of the tunica vaginalis.
A hydrocele develops between the:
1500
A mature male can produce ____ sperm a second.
prostate cancer
A patient is referred to an urologist for enlargement of the prostate found during a physical examination. The digital rectal examination reveals a hard mass in the posterior/lateral aspect. The prostate-specific antigen (PSA) value is 6.0. What is the most likely diagnosis?
teratoma
A patient with a history of undescended testis is NOT at an increased risk for which of the following?
bladder outlet obstruction, an abnormal DRE, and an abnormal PSA level
Patients with prostate cancer may present with which of the following symptoms?
patients may present with all of the symptoms below: bladder outlet obstruction, an abnormal DRE, and an abnormal PSA level
Patients with prostate cancer may present with which of the following symptoms?
young/middle aged
Testicular torsion usually occurs in _____ .
transrectal
The _____ approach is the most acceptable method of prostate sonography.
"bell clapper"
The _____ deformity is the most common underlying etiology of testicular torsion in adolescents.
epididymis
The _____ is the primary location for maturation and storage of sperm.
pampiniform
The ______ venous plexus contains cooler venous blood to absorb heat from arterial blood in the testes.
peripheral zone
The apex of the prostate is located inferior to the verumontanum and is made up predominantly of which zone?
verumontanum
The area close to the center of the prostate is called the
torsion
The doppler image below most likely demonstrates:
4 mm
The normal spermatic vein is considered dilated when it reaches what diameter?
corpus spongiosum
The penile urethra courses through what structure of the penis?
mid zone
The prostate gland is also divided into four main zones. Which of the following is NOT one of these zones?
3x3x5 cm
The prostate gland is the largest accessory sex gland in the male reproductive system, measuring approximately ______.
3 cm
The prostate gland measures approximately ____ long.
anterior
The prostate gland sits in the male pelvis _____ to the rectum.
the obturator internus and levator ani muscles.
The prostate is supported by
testicles, epididymis, and proximal vas deferens
The scrotum consists of the
urinary bladder and the rectum
The seminal vesicles are located between what two structures?
4 cm long, 3 cm in diameter (AP), 3 cm wide
The testes measure:
fibrinolysin
The white alkaline seminal fluid produced by the prostate gland includes all of the following EXCEPT:
chronic torsion
This patient presented after 5 days of testicular pain. The mixed echogenicities and lack of blood flow in the Lt testicle represents:
peripheral zone
This zone is the largest zone of the prostate and is situated on the posterior and lateral side.
central zone
This zone lies surrounds the ejaculatory duct.
left
Using the endorectal scanning plane, where on the transverse image is the RT lobe of the gland?
A cyst, found within the head of epididymis, that may contain debris
Which of the following best describes a spermatocele?
seminal vesicle cyst
Which of the following cysts will contain spermatozoa?
epithelial zone
Which of the following is NOT a zone within the glandular tissue of the prostate gland?
seminal vesicles
Which of the following is NOT located within the scrotum?
vas deferens
Which of the following is NOT one of the 3 tubes that makes up the penis?
tunica albuginea
Which of the following is the fibrous sheath that covers and protects the testis and also makes up the mediastinum testis?
AFP
Which of the following lab values may be elevated with a testicular malignancy?
occurs more frequently in Asian and American Indian men
Which of the following statements is NOT true regarding prostate cancer?
The left testicular vein drains directly into the IVC
Which of the following statements regarding the testicular veins is FALSE?
Prostate biopsy is commonly done at known sites of anatomic weakness
Which of the following statements regarding ultrasound-guided prostate biopsy is TRUE?
transition zone
Your patient presents for a sonography examination to evaluate for benign prostatic hypertrophy. Which zone is most affected by BPH?
BPH
Your patient states that he has had a transurethral resection or TURP procedure. What condition does this procedure treat?
pampiniform plexus
a network of veins that drains the epididymis and testis
valsalva maneuver
a technique in which the patient is asked to bear down to increase the intra-abdominal pressure and aid in the diagnosis of varicocele and scrotal hernia
ejaculatory ducts
duct that passes through the central zone and empties into the urethra
testicular
The primary source of blood flow to the testicles is via the _____________ arteries.
transitional zone
This zone enlarges in aging men resulting in benign prostatic hyperplasia.
Varicocele
A patient presents for a scrotal sonogram with a history of infertility. The testes appear normal bilaterally. Superior to the testes, multiple cystic structures are seen. The largest of these structures measures 4 mm. Color Doppler demonstrates flow within these structures and increased flow is seen when the patient is asked to perform the Valsalva maneuver. What is the likely diagnosis?
varicocele
A patient presents for a scrotal sonogram with a history of infertility. The testes appear normal bilaterally. Superior to the testes, multiple cystic structures are seen. The largest of these structures measures 4 mm. Color Doppler demonstrates flow within these structures and increased flow is seen when the patient is asked to perform the Valsalva maneuver. What is the likely diagnosis?
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 most likely diagnosis?
apex
inferior portion of the prostate gland
digital rectal examination
What is considered the gold standard for screening for prostate cancer?
more sensitive to low flow
What is the advantage to using color power Doppler when diagnosing testicular torsion?
seminomas
What is the most common pure germ cell tumor accounting for 40-50% of primary testicular neoplasms?
BPH
What is the most common symptomatic condition to affect the prostate gland?
fracture
What is the most likely diagnosis for the LONG penis image below on this ER trauma patient?
mediastinum testis
What is the anatomic name of a bright echogenic fibrofatty tissue often seen in the longitudinal plane within the testicle?
2-8 mm
What is the approximate normal thickness of the scrotal wall?
spermatic cord
What is the arrow in the image below pointing to in this scrotal ultrasound?
Medium level echoes
What is the echogenicity of the corpus spongiosum?
A. testis B. tail of epididymis C. body of epididymis D. head of epididymis
Label the following image:
1. bladder 2. vas deferens 3. urethra 4. epididymis 5. prostate 6. seminal vesicle
Label the following:
epididymitis
A 26-year-old man presents with fever, scrotal pain, and swelling. The sonogram shows an enlarged hypoechoic epididymis with hyperemia. A small hydrocele is noted. The testis appears normal. What is the likely diagnosis?
testicular torsion
Acute onset of testicular pain at rest is a common clinical finding with:
AFP
Alpha fetoprotein level that may be elevated with hepatocellular carcinoma and certain testicular cancers
A. bladder B. seminal vesicles C. ejaculatory ducts D. urethra E. base of penis F. sphincter muscles G. prostate
Match the anatomy of this sagittal view of the male pelvis with the corresponding letter:
A. hyperplasia B. hypertrophy
Match the term with the correct image below:
efferent ducts
Spermatozoa exit the testis through the
testicular atrophy
Symptoms for a varicocele include all of the following EXCEPT:
True
T/F: Even though BPH leads to an increased amount of prostate tissue, it does not lead to prostatic carcinoma.
homogeneous
Testicular parenchyma on ultrasound is
decreased
Testicular torsion is characterized by ____ cremasteric reflex.
corpora amylacea
calcifications commonly seen in the inner gland of the prostate
Eiffel Tower sign
shadowing created by calcification in the area of the urethra and verumontanum
False
T/F: The main function of the prostate gland is to store urine and sperm until it is time to void or ejaculate.
True
T/F: The most important finding is the absence of blood flow on color Doppler when diagnosing torsion.
True
T/F: The seminal vesicles join with the ductus deferens to form the ejaculatory ducts.
hematoma
A 15-year-old boy is hit in the scrotum by a "line drive" during a high school baseball game. He enters the ultrasound department the following day with a swollen and bruised right testicle. The results of the ultrasound evaluation are shown in Figure 2. What is the most likely diagnosis?
seminoma
A 42-year-old patient presents with a painless right scrotal mass. Sonographically, a 2.5-cm, irregular, hypoechoic mass is seen in the mid-right testis. Color Doppler demonstrates hyperemia. The remainder of the scrotum, including the scrotal wall, appears normal. What is the most likely diagnosis?
lymphoma
A 59-year-old man is seen in the ultrasound department with enlargement of the right testicle. He has had general malaise for the past month but only last week noticed the irregularity in his testicle. Ultrasound examination reveals the findings in Figure 1. What is the most likely diagnosis?
BPH
A 67-year-old man in generally good health has had difficulty in urination for the past 6 months. One morning, he awakes in extreme discomfort and is unable to urinate. What is the most likely diagnosis?
hyperemia
An increase in blood flow to the tissue
50%-100%
BPH is very common occurring in approximately ____ of men aged more than 50 years.
BPH
Based on the following image, what is Joseph's likely diagnosis?
adenocarcinoma
Based on the following image, what is Sam's likely diagnosis?
12 to 18 years of age
Between what ages is testicular torsion most common?
surgical capsule
Connective tissue separating the peripheral and central zones of the prostate is termed:
obtain Doppler spectrum without angle correction
Correct sonographic investigation for evaluation for vascular impotence would include all of the following except:
lies between the prostate and the rectum
Denonvilliers' fascia:
benign prostatic hypertrophy
Enlargement of the prostate in older men is most often caused by:
A patient starting to void then manually clamping the glans penis
Evaluation of urethral stricture should be performed with:
beta-hCG
Human chorionic gonadotropin is produced during pregnancy but is also secreted by certain testicular cancers
prostatitis
If a patient comes in with dysuria, fever & chills, and on a DRE the prostate is warm and tender, what is a likely diagnosis?
hyperechoic to the seminal vesicles.
In a scan of the prostate and seminal vesicles, the prostate appears
peripheral zone
In which zone does prostate cancer and prostatitis most often occur?
sexually transmitted disease
In young men, what is most common cause of epididymitis?
A. base B. midzone C. apex
Label the areas of the prostate below:
A. prostate gland B. ejaculatory ducts C. urethra
Label the following image of the male genitalia:
A. pubis B. glans penis C. foreskin D. penis
Label the following:
1. pampiform plexus 2. varicocele 3. epididymis 4. vas deferens
Label the image below:
1. testicle 2. epididymis
Label the image below:
A. appendix testis B. appendix epididymis C. efferent ductules D. ductus deferens E. head, body, tail of epididymis F. superior aberrant ductule G. rete testis H. tunica albuginea I. mediastinum testis J. lobules of testis K. seminiferous tubule
Label the image:
A. bladder B. rectum C. prostate
Label this image of the male pelvis below:
A. transition zone B. urethra C. peripheral zone D. central zone E. seminal vesicles F. ejaculatory duct
Match the zonal anatomy with the corresponding labels.
Stage D
Prostate cancer that has invaded the seminal vesicles and local lymph nodes is classified as:
alkaline phosphatase
Serum _______ is a serum marker that will be elevated if prostate cancer shows osteoblastic metastases.
True
T/F: The base of the penis is supported by a suspensory ligament
epididymis
What anatomy is included within the scrotum?
corpus spongiosum
What does the THIN arrow at the bottom of this LONG image represent?
Hydrocele
What is a collection of serous fluid located between the layers of the tunica vaginalis called?
hydrocele
What is a collection of serous fluid located between the layers of the tunica vaginalis called?
low level echoes
What is the echogenicity of the spermatic cord?
testicular torsion
What is the most common cause of an infarcted testicle?
Varicocele
What is the most common correctable cause of male infertility?
varicocele
What is the most common correctable cause of male infertility?
Squamous cell carcinoma
What is the most common malignancy of the penis?
varicocele
What scrotal abnormality is caused by incompetent valves within the pampiniform plexus?
enlarged torsed testicle
What sonographic appearances in this image below represents torsion?
warm compress
What technique is used to accentuate small arteries of penis for impotence evaluation?
12 MHz - 15 MHz linear
What transducer is optimal for proper visualization of penis?
infarction
tissue death that occurs due to lack of blood flow
from the ventral side
Penile arterial flow is evaluated by scanning the penis:
tunica albuginea
Peyronie's Disease is an inflammatory condition in which fibrous nodules and later calcifications form along the:
dorsal
Peyronie's disease is demonstration of calcification(s) along what portion of penis?
release secretions
The arrow referenced in the image below contains glands that:
bulb of the penis
The blue arrow is pointing to an area of the penis called:
corpus spongiosum
The blue arrow is pointing to what structure on the underneath side of the penis?
lung
The corpora amylacea are normal findings in the prostate and can be seen in normal _____ tissue as well
varicocele
The dilated spermatic cord in the image below most likely represents:
glans penis
The end of the penis where the green arrow is pointing is referred to as the:
testosterone
The endocrine function of the testicles is to produce:
vas deferens
The green arrow in the image below is pointing to what structure?
corpus cavernosum
The green arrow is pointing to what structure on the penis?
seminal vesicles
The green arrows in this male pelvis are pointing to the:
testicular torsion
The image below most likely represents what critical scrotal pathology?
peripheral zone
The largest portion of the glandular prostate is the
deep artery of the penis, bulbourethral artery, and dorsal artery
The main arterial blood supply of the penis includes the
6 weeks gestation
The male and female embryo has identical external genitalia until:
scrotum into 2 testicles
The median raphe divides the
High-resolution, high-frequency
The most appropriate transducer for penile ultrasound is:
seminoma
The most common germ cell tumor of the testis is the:
peripheral zone
The most common location of prostatic cancer is the:
impotence due to urethral "leak"
Ultrasound of the penis is performed to discover all conditions EXCEPT:
cryptorchidism
Undescended testicle
guide radiotherapy treatment
Which of the following is NOT a use of sonography for evaluation of BPH?
Patient suffering from acute prostatitis, diabetic patients, and immune-compromised patients
Which of the following patients are more likely to develop prostate abscess?
BPH affects the central zone of the prostate.
Which of the following statements regarding BPH is FALSE?
rete testis
Which of the following undergoes tubular ectasia caused by dilatation of the seminiferous tubules and is associated with epididymal cysts and spermatoceles?
peripheral zone
Which of the glandular zones of the prostate is the largest?
Ask the patient to lay prone on the examination table
Which of these steps is NOT described as something that would happen during a scrotal exam.
Flow in the cord is decreased with testicular torsion and increased with epididymitis
Which statement is critical in differentiating acute testicular torsion from an acute epididymitis?
ejaculatory duct
Which structure travels within the central zone of the prostate gland and joins the urethra?
core biopsy
Which type of biopsy uses an automatic spring-loaded device to provide tissue for analysis?