scrotum practical

centripetal arteries, recurrent rami, centrifugal

Capsular arteries give rise to ___________ arteries which course from the testicular surface toward the mediastinum along the septa. Before reaching the mediastinum they curve backward forming the ____________ _______ or ___________ arteries. These branch into arterioles and capillaries.

conical, seminiferous, rete, mediastinum

Each testis is divided into more than 250-400 ___________ tubules containing the ______________ tubules. These tubules converge at the apex of each lobule and anastomose to form the ________ testis in the ____________.

small, clear cysts that contain serous fluid. They can be found anywhere within the epididymis. asymptomatic

Epididymal cysts: what are they? contain? symptoms? Sonographic appearance?

1. D: Epididymitis refers to inflammation of the epididymis, and may be associated with inflammation extending to the testis itself, in which case the term epididymo-orchitis is used. This should be distinguished from isolated orchitis, which is by comparison much less common. 2. enlarged epididymis, heterogenous texture, hypoechoic, may contain hypoechoic areas, blood flow in the epididymis

Epididymitis 1. Description: 2. Sonographic appearance 3.

1. Orchitis is an infection of the testicle, which is rarely isolated. isolated orchitis can be seen in mumps and syphilis 2. focal: hyopechoic area within testis, blood flow in the testis diffuse: enlarged, hypoechoic testis, echogenicity of the whole testis

Focal orchitis/diffuse orchitis 1. Description: 2. Sonographic Appearance

smooth, medium gray structures with fine echo textures

How do normal testes appear sonographically?

uncommon, tiny calcifications within the testis, associated with malignancy, less than 3mm multiple bright nonshadowing foci

Microlithiasis: common? description? malignant?

tunica albuginea

Septa testis are formed from the ___________ _______________ at the mediastinum

chronic inflammatory reaction to extravasation of spermatozoa mostly seen in patients with vasectomy located anywhere within the epididymis or the vas deferens intratesticular or extratesticular?

Sperm granuloma

cystic dilations of the efferent ductules of the epididymis located in the epididymal head. spermatoceles contain proteinaceous fluid and spermatozoa often seen following vasectomy

Spermatoceles: What are they? location? contain?

Testicular artery--->capsular artery--->centripetal artery--->recurrent rami

Testicular artery branching

verumontanum

The junction of the ejaculatory ducts with the urethra is termed the _________

seminoma

The most common type of germ cell tumor is __________, followed by mixed embryonal cell tumors and teratocarcinomas.

efferent

The rete testis drains into the head of the epididymis through the ___________ ductules.

ivc, left renal vein

The right testicular vein drains into the ____________ and the left testicular vein joins the ____________

vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, autonomic nerves and fiber of the cremaster

The spermatic cord is formed by:

ampulla

The vas deferens dilates at the terminal portion near the seminal vesicles. This is called _________ of the deferens.

ejaculatory duct, urethra

The vas deferens joins the duct of the seminal vesicles to form the _______________ _______ which, in turn empties into the _________

rupture: irregular contour, focal alteration in echogenicity hematoma: heterogeneous area, becomes hyperechoic as the blood clot ages, avascular torsion: gray-scale image of testis normal when duration <4 hours testis enlarged and hypoechoic 4-12 hours testis heterogenous after 24 hours, absence of testicular flow

Trauma Sonographic appearance: rupture: hematoma: torsion:

an abnormal dilation of the veins of the pampiniform plexus (located within the spermatic cord) usually caused by incompetent venous valves within the spermatic vein more common on the left renal hydronephrosis, abdominal mass, liver cirrhosis may cause varicocele relationship with impaired fertility increase in diameter with Valsalva or patient standing tortuous dilated veins dilated veins fill with color on Valsalva maneuver spectral Doppler confirms venous flow

Varicocele: what are they? usually cause by? more common on left/right? fertility? location? sonographic appearance?

hydrocele, hematocele,

What are non-specific complications of trauma to the testes

Adults: ~3-5cm in length, 2-4cm in width, 3cm in height

What are the testis measurements?

cremasteric and deferential arteries, pudendal

What arteries supply the extratesticular structures? The scrotal wall is also supplied by braches of the ____________ artery

to determine whether a rupture has occurred: rupture is a surgical emergency that requires prompt diagnosis. If surgery is performed within 72 hours following injury 90% of testes can be saved but after 72 hours 45% of testes can be saved

What is the most important goal of the ultrasound exam in testicular trauma?

right and left testicular arteries they descend into the retroperitoneum, enter the spermatic cord and in the deep inguinal ring and pierce the tunica albuginea forming capsular arteries

What is the primary source of blood flow to the testis?

spermatic cord

What suspends the testis in the scrotum

The space between the layers of the tunica vaginalis is where hydroceles form. It is normal to see a small amount of fluid in this space Hydroceles are acquired or congenital serous fluid collection between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They are the most common form of testicular enlargement, and present with painless enlargement of the scrotum. On all modalities, hydrocoeles appear as simple fluid, unless complicated by infection or haemorrhage.

Where do hydroceles form?

abdominal aorta just below renals

Where do the right and left testicular arteries arise from?

vas deferens, it is thicker, less convoluted

continuation of the ductus epididymis is ______ _______________

human chorionic gonadotropin and alpha fetal protein

germ cell tumors are associated with elevated levels of ___________________ and ______________________ 95% of all testicular tumors are of _______ cell tumor type and are highly malignant. ________ cell tumors are generally benign.

potential space between layers (visceral and parietal layers) of tunica vaginalis. This space is where a hydrocele, pyocele or hematocele will develop. hydrocele: serous fluid, most common cause of painless scrotal swelling, may have unknown cause, commonly associated with epididymo-orchitis and torsion or trauma, development of neoplasm. pyocele: collection of pus, occur with untreated infection or when an abscess ruptures into the space between the layers of the tunica vaginalis. hematoceles: associated with trauma, surgery, neoplasms, or torsion, collection of blood hydroceles: anechoic but most often contain low-level echoes as a result of cellular debris pyoceles and hematoceles are indistinguishable, both contain internal echoes and thickened septations and loculations

hydrocele, pyocele, hematocele: where? cause?contain?

6-7cm head is the largest part of epididymis head: 6-15mm head is superior to upper pole of the testis containing 10-15 efferent ductules from the rete testis which converge to form a single duct in the body and tail known as ductus epididymis. ----> vas deferens -----> spermatic cord

length of epididymis? largest part of epididymis? measurement of head? location of head:

The tunica vaginalis lines the inner walls of the scrotum covering each testis and epididymis. consists of 2 layers: parietal and visceral

lines the inner wall of the scrotum

focal alteration of the testicular parenchymal pattern, interruption of the tunica albuginea, irregular testicular contour, scrotal wall thickening, and hematocele, combined with trauma they suggest rupture hematoceles (acute): echogenic with numerous highly visible echoes that can be seen to float or move in real-time hematoceles(overtime): show low level echoes and develop fluid-fluid levels or septations the presence of hematocele does not confirm rupture hematomas with trauma may be large - heterogenous areas within the scrotum, may become more complex over time, avascular, identification of blood flow disruption across the surface of the testis is indication for rupture

sonographic findings of scrotal rupture?

located at the hilum of the tesis where the mediastinum resides. Tubular ectasia of the rete testis is an uncommon, benign condition. Associated with the prescence of a spermatocele, epididymal or testicular cyst or other epididymal obstruction on the same side as the dilated tubules

tubular ectasia of the rete testis

pampiniform plexus, exits from the mediastinum testis and courses the spermatic cord. It converges into 3 sets of anastomotic veins: testicular, deferential and cremasteric.

venous drainage of the scrotum occurs through the veins of the _____________ ___________

testicular cancer, one of the most curable forms of cancer undescended testes are 2.5-8X more likely to develop cancer

what is the most common malignancy in men between the ages of 15-35?