Male Pelvis
Prostate cancer will elevate PSA level approximately ___ times that of benign prostatic hyperplasia.
10
At least _____ degrees of torsion is considered necessary to completely occlude testicular blood flow.
540
What type of transducer is best for scrotal sonography?
7.5-10 MHz linear
Cryptorchidism is a common genitourinary anomaly. Complete descent is necessary for full testicular maturation. Where is the undescended testicle normally found?
80% are found in the inguinal canal
Dilated veins of a varicocele will measure:
>2mm
What is the etiology of a hydrocele?
Congenital Acquired: idiopathic or trauma, torsion, etc.
What is the appendix epididymis?
Detached efferent duct
What is the most common malignancy of the testicles?
Embryonal cell carcinoma
What are the 3 sonographic findings associated with acute epididymits?
Enlarged epididymis with decreased echogenicity and inhomogenous echo texture Reactive hydrocele Skin thickening
Define benign prostatic hyperplasia (BPH).
Enlargement of the inner gland transition zone
What is the tunica vaginalis?
Extension of the peritoneum into the scrotal chamber that resides along the side of the testicle
What is the tunica albuginea?
Fibrous capsule that surrounds the testicle
What are the 5 sonographic findings of testicular torsion?
Hypoechoic or heterogenous testis, reactive hydrocele, no intratesticular flow, enlargement of the spermatic cord, epididymis, and testis, thickened scrotal wall
What are two complications of cryptorchidism?
Infertility and cancer
What is the difference between primary and secondary varicoceles?
Primary: right side Secondary: left side
Describe the Prostate-Specific Antigen (PSA).
Produced by prostatic acinar cells and rises in relationship to amount of benign and/or malignant tissue
What is the appendix testis?
Remnant of the Mullerian duct
How does the appendix testis appear sonographically?
Small ovoid structure near the head of the epididymis
Both orchitis and testicular torsion sonographically appear as an enlarged hypoechoic testicle. How would you differentiate between these two diagnoses?
Torsion: absence of intratesticular flow Orchitis: hypervascularity
What is the name of the anatomical point where the posterior sheath of the rectus muscle ends?
arcuate line
The lack of normal fixation of the testis to the posterior scrotal wall is referred to as:
bell-clapper deformity
Enlargement of the prostate in older men is most often caused by:
benign prostatic hypertrophy
What is the most common prostate condition in a male over the age of 50?
benign prostatic hypertrophy (BPH)
The most common location of a hydrocele is:
between the two layers of the tunica vaginalis
The prostate is situated in the retroperitoneum and is bordered superiorly by the:
bladder
Male infertility can result form what 3 diseases?
blocked seminal vesicles, prostatitis, prostatic lesion
A 52-year-old man presents with hydronephrosis and asymmetric prostate enlargement. This is most likely consistent with:
carcinoma
Elevated PSA is found in patients with:
carcinoma
The ejaculatory ducts pass through the ______ and empties into the urethra.
central zone
Which tumor corresponds to an elevated HCG n malse?
choricarcinoma
What is a hydrocele?
collection of serous fluid within the tunica vaginalis
What are varicoceles?
dilated, tortuous veins of the pampiniform plexus
What are extratesticular findings associated with torsion?
enlarged epididymis, skin thickening, reactive hydrocele
A hydrocele is secondary to:
epididymitis
What zone of the prostate is not affected by cancer and why?
fibromuscular stroma as it is a non-glandular, anterior portion of the prostate
How many lobe is the prostate divided into?
five
What is the sonographic appearance of a hydrocele?
fluid collection surrounding the testicle with possible low-level echoes of fibrin or cholesterol crystals
What PSA levels indicates a strong suspicion for cancer?
greater than 20ng/mL
What does the epididymis consist of?
head, body, tail
What is above the arcuate line?
hematomas are confined within the anterior and posterior rectus sheath
What is below the arcuate line?
hematomas protrude posteriorly into the pelvis due to the absence of the posterior rectus sheath
A simple fluid collection surrounding the testis is referred to as a:
hydrocele
What is the sonographic appearance of the testicular mediastinum?
hyperechoic
What is the most common sonographic appearance of a seminoma?
hypoechoic
What is the classic appearance of prostate cancer?
hypoechoic, peripherally-oriented lesion
Transverse images at the base of the prostate are used to:
image seminal vesicles
What is the cause of varicoceles?
incompetent valves in the internal spermatic vein
The apex of the prostate is the ______ portion of the gland.
inferior
If the physician's request is for evaluation of cryptorchidism, the sonorapher should pay particular attention to which area?
inguinal canal
What are 4 characteristics of a testicular appendage torsion?
intratesticular flow, small hyperechoic mass adjacent to the testis, reactive hydrocele, scrotal wall thickening
Where do varicoceles most commonly appear?
left side as the left gonadal veins drains into the left renal vein
The most common location of a varicocele is:
left side of the scrotum
What are three characteristics of primary varicoceles?
left side, infertility, palpable extratesticular mass
Normal testicular artery flow is considered:
low resistive with broad systolic peaks
The term cryptorchidism denotes:
one or both of the testicles has not descended into the scrotum
What four factors are associated with the increase of PSA in the blood?
patient age, prostate volume, benign prostatic hyperplasia, prostate cancer
Carcinoma of the prostate is most often found in the:
peripheral zone
The most common location of prostatic cancer is the:
peripheral zone
What zone is the source of most prostate cancers?
peripheral zone
Name the four zones of the prostate.
peripheral, transition, central, fibromuscular stroma
The seminal vesicles are located:
posterior to the bladder and superior to the prostate
What ultrasound settings will help evaluate color flow in the testicles?
power Doppler, higher frequency, lowest fileters
What is the most common cancer found in men?
prostate cancer
A male patient present sonographically with a hypervascular noncompressible mass noted in the peripheral zone and ejaculatory ducts filled with calculi. The most likely diagnosis is:
prostatis
The prostate is situated in the retroperitoneum and is bordered anteriorly by the:
pubic bone
The prostate is situated in the retroperitoneum and is bordered posteriorly by the:
rectum
Spermatogenesis occurs within the:
seminiferous tubules
A 30-year-old presents with unilateral testicular enlargement and no pain. This is characteristic of which disease?
seminoma
The most common germ cell tumor of the testis is the:
seminoma
What is a spermatocele? (3)
simple cyst, found within the head of the epididymis, may contain debris
How does the appendix epididmis appear sonographically?
small stalk projecting off the epididymis
The exocrine function of the testicles is to produce:
sperm
A common cyst most often seen in the head of the epididymis that contains nonviable sperm is the:
spermatocele
The base of the prostate is the ______ portion of the gland.
superior
Seminal vesicles are two sac-like out-pouchings of the vas deferens situated adjacent to the ______ and ______ aspect of the prostate between the urinary bladder and rectum.
superior, posterior
The demarcation between the inner gland and the outer gland is called the:
surgical capsule
Which intratesticular tumor is more prevalent in the pediatric age group?
teratoma
What are the sonographic findings associated with torsion of the spermatic cord?
testicle becomes enlarged, inhomogenous, and hypoechoic
Acute onset of testicular pain at rest is a common clinical finding with:
testicular torsion
Visceral layer of the tunica vaginalis covers:
testis and epididymis
The endocrine function of the testicles is to produce:
testosterone
Parietal layer of the tunica vaginalis lines:
the walls of the scrotal chamber with a small amount of fluid
A patient presents with acute scrotal pain and unilateral enlargement. A sonographic examination is performed and the testicular parenchyma is hypoechoic with decreased vascular flow. This is consistent with:
torsion
A 7-year-old boy presents to the emergency department with acute testicular pain localized to the superior pole of his right testis. What is the most likely diagnosis?
torsion of the testicular appendage
The blue dot sign is indicative of:
torsion of the testicular appendage
What are the two most common causes of acute scrotal pain?
torsion, epididymo-orchitis
Benign prostatic hypertrophy (BPH) usually occurs in what zone?
transitional
The most common location of benign prostatic hypertrophy is the:
transitional zone
The prostate is situated in the retroperitoneum and is bordered inferiorly by the:
urogeital diaphragm
Which technique is useful at providing sonographic evidence of a varicocele?
valsalva maneuver
A dilated group of veins found within the scrotum is defined as:
varicocele
What is the most common correctable cause of male infertility?
varicocele
What scrotal abnormality is caused by incompetent valves within the pampiniform plexus?
varicocele
Hydrocele fluid is located between which two layers:
visceral and parieta tunica vaginalis
