scrotum pathology

ischemia

deficiency of blood supply

when pt presents with acute scrotum pain one must

determine if rupture is present

Sonographic Findings Epididymitis appears as

enlarged, hypoechoic gland, and Hyperemic flow confirmed with color Doppler.

Epididymo-orchitis is infection of

epididymis and testis.

Epididymal cysts are small, clear cysts containing serous fluid located within the

epididymis.

Epididymitis may result from trauma; color Doppler imaging can be used to identify associated increased vascularity in

epididymis.

Acute painful Scrotum

epididymitis and epididymo-orchitis are th emost common causes of acute scrotal pain

Epididymo-orchitis Usually occurs secondary to

epidiymitis.

Most scrotal cysts are __________, found in tunica albuginea or epididymis.

extratesticular

choriocarcinoma sonographic findings

heterogeneous and show extensive hemorrhagic necrosis in the central portion of the tumor with a mixed echo pattern

embryonal cell carcinoma sonographic findings

hypoechoic mass with poorly defined borders. calcifications and echogenic foci are not uncommon.

hyperemia

increased blood flow to tissue

epididymitis

inflammation of the epididymis

Epididymal cysts, spermatoceles, and tunica albuginea cysts are generally asymptomatic but may be __________

palpable.

A varicocele is an abnormal dilation of veins of pampiniform plexus, which is located within the _____ _______

spermatic cord

Torsion of spermatic cord is a _____ _______

surgical emergency.

inflammation usually begins at the

tail

teratoma sonographic findings

tend to be very large and markedly inhomogenous masses

infarction

tissue death that occurs due to lack of blood flow

Color Doppler used to confirm absence of flow in testis with

torsion.

Hydrocele and hematocele are both complications of

trauma.

Pyocele occurs when pus fills space between layers of

tunica vaginalis.

epididymitis is usually

unilateral

sonographic findings of seminoma

well-defined homogenous hypoechoic mass without calcification or tunica invasion

Rete testis is located at hilum of testis where mediastinum resides.

...

Torsion can occur at any age; peak incidence at age

14.

After 12 hours only ____ will be saved.

20%

the entire epididymis is affected in _____ of cases

50%

Between 6 and 12 hours salvage rate is ______

70%.

If surgery performed within 5 to 6 hours of onset of pain, ____ to _____ of testes can be salvaged.

80% to 100%

Spermatoceles are cystic dilatations of efferent ductules of epididymis.

Always located in epididymal head. Contain proteinaceous fluid and spermatozoa. May be seen more often following vasectomy .

what is the Most common cause of acute scrotal pain in adults?

Epididymo-orchitis

Cryptorchidism

Failure of one or both of testes to descend into scrotum Prevents normal sperm development

Sonographic findings associated with scrotal rupture:

Focal alteration of testicular parenchymal pattern. Interruption of tunica albuginea. Irregular testicular contour. Scrotal wall thickening. Hematocele

Metastasis

Metastasis to testicle is rare, normally occurring later in life. Metastasis to testicle is bilateral, with multiple lesions found.

Torsion

Occurs as result of abnormal mobility of testis within scrotum. Testis and epididymis twist within scrotum, cutting off vascular supply within spermatic cord.

Pathway of sperm development

Seminiferous tubules. Tubuli recti. Rete testis. Efferent ductules. Ductus epididymis. Vas deferens.

Metastasis Sonographic Findings

Solid hypoechoic mass Hyperechoic Mixture of both

Presenting symptoms of torsion

Sudden onset of scrotal pain with swelling on affected side. Severe pain causes nausea and vomiting in many patients.

yolk sac tumor

accounts for 80% or childhood testicular cancers. most occurring before 2 years of age. AFP is elevated.

Hematoceles are collections of ________ associated with trauma, surgery, neoplasms, or torsion.

blood

usually secondary to

chlamydia and gonorrhoeae

Normal epididymis shows ______ flow with color Doppler.

little

Epididymo-orchitis Most commonly results from spread of

lower urinary tract infection via spermatic cord.

Affected side shows significantly _____ flow than asymptomatic epididymis.

more

lymphoma

most common bilateral testicular tumor. typical in older pts. aggressive and infiltrates the epididymis and spermatic cord.

Seminoma

most common pure germ cell tumor. common in pts with microlithiasis. Alphafetoprotien level is normal

extravaginal torsion occurs exclusively in

newborns

lymphoma sonoghraphic findings

nonspecific

yolk sac tumor sonographic findings

nonspecific. inhomogenous and may contain echogenic foci

Pyocele is a collection of

pus.

leukemia

rare.

choriocarcinoma

rare. elevated levels of beta-HCG. Has the worst prognosis of all germ cell tumors, with death occurring within 1 year of diagnosis.

Blood flow disruption across surface of testis indicates

rupture.

Presence of hematocele does not confirm

rupture.

Important to use ____ color Doppler settings when comparing amount of flow between sides.

same

Scrotal hernias occur when bowel, omentum, or other structures herniate into

scrotum.

teratoma

second most common testicular neoplasm in children. contain multiple tissue elements such as bone, soft tissue, and cartilage.

embryonal cell carcinoma

second most common testicular tumor. invades the tunica and distorts testicular contour. Most aggressive malignancy. AFP and beta-human chorionic gonadotropic levels elevated