ARDMS AB- male pelvis

sonographic findings of prostatitis

1. Enlarged, hypoechoic prostate 2. Hypermia evident with color Doppler

sonographic findings of acute testicular torsion

1. Enlargement of the spermatic cord, epididymis, and testis 2. Thickened scrotal wall 3. Hypoechoic or heterogeneous testis 4. Reactive hydrocele 5. No intratesticular flow 6. Decreased intratesticular flow (as compared to the asymptomatic testis)

clinical findings of prostatitis

1. Hematospermia 2. Painful ejaculation 3. Perineal pain 4. Dysuria

clinical findings of BPH

1. Nocturia 2. Increased urinary frequency 3. Sense of urinary urgency 4. Constant feeling of having a full bladder 5. Elevated PSA

clinical findings of cryptorchidism

1. One or both testicles not palpable within the scrotum

clinical findings of testicular abscess

1. Painful, swollen scrotum 2. Fever 3. Elevated white blood cell count

sonographic findings of scrotal trauma

1. Possible fracture line 2. Indistinct testicular margins 3. Hematocele

sonographic findings of a seminoma

1. Solid, hypoechoic intratesticular mass 2. Large seminomas may become heterogeneous

sonographic findings of a varicocele

1. a group of anechoic, tubular structures located outside of the testis 2. distended veins that fill with color flow when the valsalva maneuver is performed 3. dilated veins that measure greater than 2 mm 4. possibly associated with hydronephrosis, hepatomegaly, or a retroperitoneal neoplasm if found on the right

clinical findings of acute testicular torsion

1. acute onset of testicular pain (often during sleep) 2. possible pain within the lower abdomen and inguinal region 3. swollen testis/scrotum 4. nausea and vomiting 5. higher positioned, painful testis with a horizontal position

sonographic findings of testicular abscess

1. complex intratesticular mass 2. mass that has no flow centrally but increased flow around its margins 3. may have a co-existing pyocele

clinical findings of prostate cancer

1. elevated PSA 2. enlarged prostate 3. blood in the urine or semen 4. back pain, pelvic pain, hip or thigh pain 5. impotence 6. decrease in the amount of ejaculated fluid

sonographic findings of chronic testicular torsion

1. enlargement of the spermatic cord, epididymis, and testis 2. no intratesticular flow 3. hyperemic flow around the testis 4. heterogeneous testis with areas of necrosis

sonographic findings of a scrotal pearl

1. extremely echogenic, mobile extratesticular structure that produces acoustic shadowing

clinical findings of a seminoma

1. painless scrotal mass 2. hardening of the testis 3. elevated hCG

sonographic findings of a hydrocele

1. simple fluid anterior to the testis 2. scrotal wall thickening 3. chronic hydroceles may have internal debris and septations

components of the spermatic cord

1. testicular artery 2. pampiniform plexus 3. lymph nodes 4. nerves 5. cremaster muscle

clinical findings of a hydrocele

1. transilluminates light 2. painless scrotal swelling 3. may present with pain when found in the presence of scrotal infections, testicular torsion, trauma or a tumor

clinical findings of a hematocele

1. trauma to the pelvis or scrotum 2. recent pelvic or scrotal surgery 3. low hematocrit

clinical findings of a varicocele

1. typically painless (large varicoceles can cause discomfort) 2. palpable extratesticular mass 3. possible infertility

sonographic findings of prostate cancer

1. varying sonographic appearances 2. hypoechoic mass 3. may be hypervascular

sex cord-stromal tumors

Leydig cell tumor, Sertoli cell tumor

What is the bulbourethral gland?

Produce clear slippery fluid that lubricates head of penis during sexual arousal also protects the sperm by neutralizing the acidity of residual urine in the urethra

clinical findings of epididymitis and epididymo-orchitis

acute testicular pain leukocytosis fever dysuria uretheral discharge scrotal wall edema

clinical findings of the testicular appendage

acute testicular pain pain localized to the superior pole of the testis blue dot sign

sonographic findings of seminal vesicle cyst

anechoic or complex cystic structures in the area of seminal vesicles

where does sperm mature and store

epididymis

what is the most common cause of acute scrotal pain in adults

epididymitis

What is cryptorchidism?

failure of testes to descend

what lab values differentiate between benign and malignant masses

hCG AFP

sonographic findings of an inguinal hernia

heterogenous mass within the scrotum that moves mass may contain air and fluid hydrocele may be present

clinical findings of adrenal rest

history of congenital adrenal hyperplasia elevated adrenocorticotropic hormone

clinical findings of penile trauma

history of hearing an audible popping sound during intercourse subcutaneous bleeding area

clinical findings of a spermatocele, epididymal cyst, and tunica albuginea cyst

if large enough, can be palpable typically not painfull

clinical findings of peyronie disease

impotence, painful erections, area of scar tissue can typically be palpated, marked curvature of the penis

characteristics of an embyronal cell carcinoma

malignant elevated hCG and AFP heterogenous with cystic components affect younger men 20-30

what is the most common malignancy associated with undescended testes

seminoma

what is the most common malignant neoplasm in the testis and affects 30-50 year olds

seminoma

what is the tunica dartos

separates the scrotum into two halves internally

what double layer surrounds the testis

tunica vaginalis

sonographic findings of a pyocele

1. Complex fluid collection within the scrotum 2. Scrotal wall thickening 3. May be seen in conjunction with rupture of a testicular abscess.

where are hydroceles located

located between the two layers of the tunica vaginalis

what are microliths associated with

malignancies infertility klinefelter syndrome cryptorchidism

characteristics of yolk sac tumors

malignant elevated AFP only heterogenous mass with areas of hemorrhage and calcifications in children less than 2 years olf

characteristics of a choriocarcinoma

malignant elevated hCG heterogenous mass with area of hemorrhage, necrosis, and calcifications

peripheral zone of the prostate

posterior lateral, apical gland largest prostatic zone most common site for malignancy

what is the most common cancer in men

prostate cancer form of adenocarcinoma

germ cell tumors of the testicle

pure seminoma teratoma embryonal cell carcinoma yolk sac tumor choriocarcinoma burned out germ cell tumor

what is the appendix testis a result of

remnants of the mullerian, wolffian, and mesonephric duct

what is the difference between left and right varicoceles

right sided: may be associated with right sided pathology of the retroperitoneum including hepatomegaly, hepatic mass, or right sided renalmass left: most common. longer vein that can be trapped

sonographic findings of a spermatocele, epididymal cyst, and tunica albuginea cyst

round, anechoic mass with acoustic enhancement may contain layering debris

clinical findings of seminal vesicle cysts

1. Asymptomatic 2. May be associated with Zinner syndrome (perineal pain, recurrent prostatitis, painful ejaculation, and infertility)

sonographic findings of adrenal rests

1. Bilateral, round, hypoechoic, intratesticular masses (most commonly near the mediastinum testis)

sonographic findings of penile trauma

1. An irregular hypoechoic or hyperechoic defect at the site of rupture

what can elevated PSA indicate

BPH prostatic cancer prostatitis prostatic infacrts normal PSA can be found in presence of cancer as well

sonographic findings of benign prostatic hypertrophy

BPH will show an enlargement of the inner gland can lead to hypoechoic areas within the gland calcifications within the gland diffusely heterogenous gland cystic changes within the gland

how does sperm travel

Epi--> Vas Deferens---> Seminal Vesicles --> ejaculatory duct

what is the bell clapper deformity

Failure of normal posterior anchoring of the gubernaculum, epididymis and testis So called because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell. Trauma can also be causative.

what is the blue dot sign

Torsion of the appendix testis

clinical findings of scrotal trauma

Trauma to the scrotum resulting in acute scrotal pain Low hematocrit

central zone of prostate

base of prostate second largest prostatic zone

what surrounds all three corpa

bucks fascia

what is a common cause of epididymitis in younger men

clamydia and gonorrhea

sonographic findings of hemaocele

complex fluid collection within the scrotum scrotal wall thickening

what are the three components of the penis

corpus spongiosum two corpus cavernosa

what is the median raphe

divides scrotum

periurethral glandular zone

embedded in the muscle of the proximal urethra smallest prostatic zone

sonographic findings of epidymitis and epididymo-orchitis

enlargement of the entire epididymis (diffuse) enlargement of only part of the epididymis (focal) hypoechoic echotexture of the affected sections of epi hypoechoi testis (with orchitis) hyeremia within the epi and testis thickened scrotal wall reactive hydrocele

where is an undescended testis most often found?

inguinal canal

where does the vascular supply of the penis start

internal pudendal artery (a tributary of the internal iliac artery)

what will flow appear like in a torsed testis

lack flow completely or have decreased flow compared to the normal testis

what is flow in intratesticular abcesses

lack of detected flow within them, they are often surrounded by hyperemic flow

what are microliths

multiple echogeniv foci with no acoustic shadowing

what is tubular ectasia

multiple small intratesticular cysts along the mediastinum. dilation of rete testis

sonographic findings of torsion of the testicular appendage

normal intratesticular flow small, avascular, hypoechoic or hyperechoic mass adjacent to the superior pole of the testis reactive hydrocele scrotal wall thickening

transitional zone

on both sides of proximal urethra site for benign prostatic hyperplasia BPH second most common site of malignancy

where is prostate cancer most commonly located

peripheral zone

clinical findings of an inguinal hernia

persistent or intermittent scrotal swelling may have abdominal pain and blood in stool

what is the most common scrotal mass

spermatocele

difference between a spermatocele, epididymal cyst, and tunica albuginea cyst

spermatocele: head of the epi epididymal cyst: anywhere along the length of the epi tunica albuginea cyst: periphery of the testicle

what is the flow of spermogenesis

spermatogenesis occurs within the seminiferous tubules that are found throughout each testis. these tiny tubules converge into the rete testis (in the mediastinum)

sonographic findings of cyrptochidism

testis located outside of scrotum hypoechoic to normal testis

sonographic findings of peyronie disease

thickening of tunica albuginea that may also contain areas of calcification

what is the most common cause of acute scrotal pain in prepubertal boys

torsion of the appendix testis

where is BPH located

transitional zone

what surrounds the corpus cavernos and partial corpus spongiosum

tunica albugenia

what is the dense fibrous tissue that is right next to the testis

tunica albuginea

what is the most correctable cause of male infertility

varicoceles

what is vascular impotence in a penis

vascular compromise to or within the penis that results in inability to obtain or maintain an erection

what does a epidermoid cyst appear like in the testis

whorled or onion skin appearance