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