Small Parts: Scrotum (Notes pg. 68 - 81)

What is the potential space and what are normal measurements?

Space between the parietal and visceral layers of the tunica vaginalis; normal to see to see 1-2 mm of serous fluid in this space

_____ must be frequently changed for an accurate texture; we can also manually compress fluid in front of testis, and re-scan.

TGC

_____________ = the passage of light through body tissues for the purpose of evaluating the structure of the tissues.

Transillumination

______________ is known to involve extra-pulmonary sites in almost 50% of cases of patients with AIDS.

Tuberculosis

Treatment for undescended testis:

Undescended testes can be placed in the scrotum by administering hormones or by surgical means (orchiopexy). If this is done by around age 6 the risk of sterility is lessened, although the risk for cancer in the future is still greater than normal.

The ________ muscle, along with the smooth muscle fibers of the scrotum (______ _____) elevates the testes during sexual stimulation and exposure to cold

1. cremaster 2. dartos tunic

When the testes do not descend, the condition is referred to as ___________; if this is not corrected it results in _______ because the cells involved in the initial development of sperm cells are destroyed by the higher body temperature of the pelvic cavity.

1. cryptorchidism 2. sterility

The majority of _________ lesions will prove to be benign, secondary to i________ or _________ ________ but rarely echogenic or complex malignancies can occur.

1. echogenic 2. nfarction or infectious processes

Most hydroceles are _________ or from _________ or ________, but about 10% of _______ ______ have an associated hydrocele.

1. idiopathic 2. epididymitis or trauma 3. malignant neoplasms

The problem with MRI is that the child has to be __________ for a long time, therefore, ultrasound is often used as the ______ modality, with MRI being used if ultrasound is unsuccessful in locating the testicle.

1. immobilized 2. initial

In patients with epididymitis, epididymoorchitis and isolated orchitis, color Doppler will show _________ blood flow due to tissue _________

1. increased 2. hyperemia

With chronic inflammations, _________ _________ may be seen. ___________ may also be present with chronic epididymitis, epididymoorchitis or orchitis.

1. increased echogenicity 2. Calcifications

The spermatic cord passes through the _______ ______, which is a slit like passageway in the _________ abdominal wall just ________ to the medial half of the inguinal ligament.

1. inguinal canal 2. anterior 3. superior

More than __ mm of fluid in the potential space of the tunica vaginalis is consistent with a hydrocele.

2 mm

Between what ages is testicular torsion most common? 1) 6 to 12 years of age 2) 12 to 18 years of age 3) 22 to 30 years of age 4) 40 to 50 years of age

2) 12 to 18 years of age

Which of the following lab values may be elevated with a testicular malignancy? 1) PSA 2) AFP 3) ALP 4) AST

2) AFP

A 26-year-old man presents with fever, scrotal pain, and swelling. The sonogram shows an enlarged hypoechoic epididymis with hyperemia. A small hydrocele is noted. The testis appears normal. What is the likely diagnosis? 1) Orchitis 2) Epididymitis 3) Epididymo-orchitis 4) Testicular torsion

2) Epididymitis

Ductus epididymis measurement:

20 feet (or 6 meters) length, <1 mm in diameter.

___________ = any steroid hormone that increases male characteristics.

Androgen

Treatment for acute epidiymitis:

Antibiotic treatment usually resolves the infection fairly quickly. If untreated or inadequately treated, the condition may become chronic or an abscess may form.

What are epididymis?

Comma shaped organs that curve along posterior margin of each testicle to inferior pole.

Sonographic appearance of epididymis:

Courser in echotexture (compared to testis), slightly more echogenic.

______ in the testes were once thought to be rare but are being found more often.

Cysts

_________ ______: relatively circular echo-free area on TRV scans along the POST. MEDIAL ASPECT of each testes.

Ductus deferens

________ _______ is ESSENTIAL to avoid irreversible damage from torsion.

Early diagnosis

What is the tunica albuginea?

Echogenic fibrous covering that envelops entire testes surface.

________ _______ (hernias where the blood supply is obstructed) will not show peristalsis and if not surgically corrected within a few hours will become gangrenous.

Incarcerated hernias

Variosceles are more common on the _______ probably because the left gonadal vein drains into LRV, whereas the right gonadal vein drains directly into IVC (The pampiniform plexus drains into other veins first, then these.)

LEFT

Varioceles generally present as:

Lumpy mass effect, especially when patient is standing may be described as feeling like a bunch of worms.

Ultrasound or MRI is the exam of choice for location of undescended testicles. ____________ is probably better.

MRI

Process of sperm maturation:

Mature sperm more from convoluted seminiferous tubules --> straight tubules in testes mediastinum --> then to network of ducts in testes (rete testis) --> The sperm are transported out of the testes through coiled efferent ducts --> the sperm next empty into a tube called the ductus epididymis.

________ _______: highly attenuative area on MEDIAL SIDE of each testes.

Median raphe

___________ appears as linear structure in center of testicle on SAG scans.

Mediastinum

The arteries to the epididymis are more difficult to identify. ________ ______ may be helpful.

Power (amplitude) Doppler

Function of testis:

Produces sperm and testosterone.

Pyocele:

Pus-filled potential space between layers of tunica vaginalis.

A _________ follows rupture of an abscess and pus fills the potential space between the layers of the tunica vaginalis.

Pyocele

______ _______: tubules that receive sperm from seminiferous tubules and send it to ductus epididymis via efferent ducts.

Rete testes

_______ ______: 2 pouch-like structures that lie post. to bladder and add fluid to ejaculate.

Seminal vesicles

__________ is the most common germ-cell tumor and accounts for 40% to 50% of all testicular neoplasms.

Seminoma

Embedded between the developing sperm cells in the tubules are ______ ______ that supply nutrients to the spermatozoa.

Sertoli cells

________ _______: Small tube that transports sperm from each testis to prostatic urethra.

Vas deferens

___________: sterilization; a portion of each ductus deferens is removed.

Vasectomy

With ________ hydroceles, the sonographic findings may include scrotal wall thickening and septations in the fluid area resulting from old hemorrhage or infection.

chronic

Chronic epididymitis presents as:

chronic enlargement of the scrotum

Cells in rete tests have ________ that push sperm along

cilia

Between the seminiferous tubules are:

clusters of interstitial cells of Leydig

The ___________ artery (arises from the inferior epigastic artery) and supplies the scrotal wall and muscle.

cremasteric

Function of scrotum:

holds testicles outside of body cavity.

Spermatic cord should be scanned from:

inguinal canal to scrotum.

For optimal results, the Doppler settings should be adjusted for ______ velocities to visualize the small testicular arteries.

low

All intra-testicular lesions should be considered __________ until proven otherwise.

malignant

The _______________ is the thickened portion of the tunica albugeina layer after it has inserted into testes.

mediastinum

With the increased incidence of AIDS and associated tuberculosis it is important to consider ________ _______ and _________ in the differential diagnosis of diffuse and focal testicular lesions

tuberculosis orchitis and epididymitis

Supra-testicular artery waveforms:

vary in appearance low resistance (testicular) and high resistance may be seen with cremasteric and deferential arteries.

Spermatoceles appear as:

usually round and occasionally septated; a cystic accumulation of sperm, lymphocytes, fat globules and cellular debris, usually in a ductule leading from the testes to the epididymis, *near the head of the epididymis.*

The release of FSH is controlled from the __________ by _________ and __________ ; releasing factors of the gonadotropic hormones

1. hypothalamus 2. FSHRF (releasing factor) and ICSHRF (releasing factor) follicle stimulating hormone releasing factor and interstitial cell stimulating hormone releasing factor).

Metastatic disease, lymphoma, or leukemia in the testicle usually has one of two sonographic appearances:

1. In some cases, one or more intra-testicular masses are identified. 2. In others, the involved testicle is enlarged and there are ill-defined areas of decreased echogenicity that gradually blend into normal testicular parenchyma.

__________ to the urinary bladder, each ductus deferens joins its _______ _______

1. Posterior 2. ejaculatory duct.

______ ______ are inguinal hernias that descend into the scrotum. Visualization of _________ confirms the presence of bowel in the scrotum.

1. Scrotal hernias 2. peristalsis

Scrotal sac has 4 layers:

1. Skin 2. Dartos tunic ("Dartos) 3. Tunica vaginalis 4. Tunica albuginea

Formed by dilation of veins of pampiniform plexus (veins that drain scrotal contents) to a size greater than __ mm.

1. Varicocele 2. 2 mm

Testicular arteries arise from the ______ ______, _______ to renal arteries.

1. abd. aorta 2. inferior

TRV scan demonstrating both testes is good for ___________; this can be done using ______ ______

1. comparison 2. SPLIT SCREEN

Since hydroceles may be ________ or associated with ______ ______, __________, or _______ ________, careful analysis of the acoustic texture of the glandular elements of the testes is important

1. congenital 2. prior trauma 3. infection 4. occult neoplasms

Exposure to cold causes _________ of the smooth muscle fibers which moves the testes ______ to the pelvic cavity where they can absorb heat.

1. contraction 2. closer

Appears of testis varies according to the amount of _______/______ ______ present best to visualize between ages ___-____yrs old.

1. fibrous/fatty tissue 2. 15-60

Larger portion of epididymis is the ________ or (globus major) and is _______ to testes and consists of ______ ______ that empty into ductus epididymis.

1. head 2. superior 3. efferent ducts

Sperm production requires a temp that's _______ than body temp. - Because the scrotum is located outside the body cavity, it supplies a temp ___ degrees below body temp.

1. lower 2. 3 degrees

Spermatic cord is attached to testis at ______ _______ where the testicular artery divides into many branches coursing along periphery, called _______ ________

1. mediastinum testis 2. "capsular arteries".

Extra-testicular tumors arising from the spermatic cord are most often of ___________ origin, whereas those arising from the tunica or epididymis are often _______ ________ ________.

1. mesenchymal 2. benign adenomatoid tumors

Indications for testicular exam:

1. pain in scrotum 2. search for undescended testicle 3. palpable mass 4. enlargement or decrease in size 5. follow-up for patients with a previous orchiectomy for recurrent tumor 6. trauma or torsion

Body of epididymis is ________ to testes and contains main portion of ______ _______

1. posterior 2. ductus epididymis.

The testes develop high on the embryo's ________ _______ _______, and at about 2 months prior to birth they _______ into the scrotum.

1. posterior abdominal wall 2. descend

The epididymis is normally strongly attached to the ___________ aspect of the testes, and it stores _______ ______ prior to ejaculation. It propels sperm toward the seminal vesicles and urethra during ejaculation by: ____________ __________ of the _________ _______.

1. posterolateral 2. sperm cells 3. peristaltic contractions of the smooth muscle.

With varicocele, the veins become ________ when the patient is standing or when he performs a Valsalva maneuver or the abdomen is compressed, and the area may be tender to the touch (but usually not). Most often the patient is __________.

1. prominent 2. asymptomatic

Internally, the scrotum is divided by a ________ into _____ _____, each containing a ______.

1. septum 2. two sacs 3. testis

Externally, the scrotum looks like a ________ ______ of _____ separated into lateral portions by a median ridge called the _______.

1. single pouch of skin 2. raphe

Mesenchymal tumors of the ______ ________, including fibromas, lipomas and angiomas are located along the course of the spermatic cord and usually are ___________ in echogenicity with ________ ______ margins

1. spermatic cord 2. homogeneous 3. clearly defined

FSH acts on the seminiferous tubules to initiate __________. ICSH also acts on the seminiferous tubules to assist the tubules in _______ _______ _______, but its chief function is to *stimulate the interstitial cells of _______ to _______ _______*

1. spermatogenesis 2. developing mature sperm 3. Leydig; *secrete testosterone*

Both ejaculatory ducts eject ___________ into the _______ _______. The urethra is the ______ _______ of the system and it serves as a common passageway for __________ and _________.

1. spermatozoa 2. prostatic urethra 3. terminal duct 4. spermatozoa and urine.

The smaller and more inferior portion is the ______ (globus minor) of epididymis and is _______ and ______ to testes.

1. tail 2. posterior and inferior

In addition, undescended testicles are almost 50 times more likely to have: ________ _________. There is also an increased incidence of _________ in cryptorchid testicles treated by orchiopexy. Undescended testes are also at increased risk for _______.

1. testicular malignancies. 2. carcinoma 3. torsion

The scrotum may be supported with a ______ or by ____ _______ of the operator.

1. towel 2. one hand

The testes are against and attached to the scrotal wall in the area posteriorly which is not covered by the ________ ______, helping to prevent _______.

1. tunica vaginalis 2. torsion

The __________ layer of the tunica vaginalis is close to the testes and the __________ layer is the outer layer.

1. visceral 2. parietal

What are the 2 layers of the tunica vaginalis?

1. visceral and 2. parietal; with a potential space in between.

Area of inguinal canal and cord represents a _____ _____ in abd wall which is a frequent site of _______ ______

1. weak spot 2. inguinal hernia.

After __ hours: salvageability drops to 20%

12 hours

Three frequently encountered pathologies involving the acutely enlarged and painful scrotum are:

acute torsion, acute scrotal trauma and *acute epididymitis (the most common).*

__________ = constructive process where simple substances are made into more complex ones

anabolism

Cremastic and deferential arteries __________ with testicular artery to supply blood to testicles.

anastomose

The _________ ______ is also found in the same general area and is a remnant of the mesonephros, which is the primitive excretory tube in the embryo.

appendix epididymis

The _______ ______ is a vestigial remnant of the Mullerian duct and lies beneath the head of the epididymis.

appendix testis

Sonographic appearances of acute epididymitis, epididymoorchitis, or diffuse orchitis:

are enlargement and decreased echogenicity of the affected structure.

If any abnormality in testicle texture is noted there is an increased probability of:

damage to glandular elements

The __________ artery branches from the vesicle artery and supplies the vas deferens and the epididymis.

deferential

It is CRITICAL to differentiate: ________ from __________.

epididymitis from torsion.

The majority of _____-________ lesions will be inflammatory, traumatic or represent benign neoplasms; these tumors are rare.

extra-testicular

With ________ orchitis, there are areas of decreased echogenicity and patchy hyperemia (increased blood flow) using color Doppler.

focal

Testicular metastases may arise from a variety of primary tumors, most commonly from the__________ _____ and less often from the lungs or GI tract

genitourinary tract

Around 95 - 97% are malignant: ____-____ _______.

germ-cell tumors

Other causes of epidiymitis:

gonorrhea, tuberculosis, trauma.

A _________ (a cavity or space filled with blood) can occur from trauma, surgery, atherosclerotic disease, diabetes or neoplasms. These arise when hemorrhage occurs between the layers of the tunica vaginalis

hematocele

Abnormal enlargement of the potential space can be due to:

herniation of bowel/hydrocele/hematocele.

Normal capsular and intratesticular artery waveforms:

high levels of antegrade diastolic flow through cardiac cycle, with low vascular resistance.

In the presence of a _________, the appendix testes and the appendix epididymis (one or both) can be visualized lying between the epididymis and the superior pole of the testes.

hydrocele

Uncomplicated acute epididymitis presents ultrasonically as:

hypoechoic, and enlarged, very often with a hydrocele. If it is not treated, it may progress to involve the testes

The hydrocele may have calcifications that produce shadows. These are seen after inflammation of the tunica vaginalis and are known as scrotaThe hydrocele may have calcifications which produce shadows. These are seen after inflammation of the tunica vaginalis and are known as:

scrotal pearls

Sonographic appearance of the mediastinum:

seen in the center of the testicle as a linear echogenic structure on longitudinal scans and as an oval echogenic structure near the middle of the testes near the medial wall on transverse scans.

Many malignancies have _______ appearances

similar

THE HALLMARK of this simple acute hydrocele, is the presence of a _______ _______ _______ _______ ______, with exception of attachment of scrotum.

simple fluid collection surrounding testes

The epididymis shrinks with age, and small epididymides tend to be associated with:

small testes

Torsion of the testes is:

the axial rotation of the spermatic cord cutting off the blood supply to the testes.

What constitues the spermatic cords?

the testicular artery, cremasteric artery and differential artery, autonomic nerves, veins that drain the testes, and lymphatics

As the testes descend, a portion of the peritoneum (called the peritoneum processus or processus vaginalis) covers them, and after birth this peritoneum closes off and is called the:

tunica vaginalis

Epidiymitis is usually unilateral or bilateral?

unilateral

What is the tunica vaginalis?

Peritoneum made up of 2 layers: visceral and parietal, with a potential space in between.

The testicle is a common site for _________ and _________.

leukemia and lymphoma.

Epidiymis is located on the __________ aspect of testes.

posterolateral

The key ultrasonic feature of malignanies is the __________ of the acoustic texture of the affected area of the testis, with decreased and/or increased reflectivity. Most testicular tumors tend to have __________ echogenicity and most are _______, _______ masses, however diffuse lesions can infiltrate the entire gland.

1. inhomogeneity 2. DECREASED 3. focal, single

The interior of the testicles are divided into ________ -- about ____-____ of them. Each lobe is filled with convoluted (rolled together or coiled) _______ _________, and ________ is produced in these tubules by a process called ____________.

1. lobules 2. 250 - 400 3. seminiferous tubule 4. sperm 5. spermatogenesis

Epidiymitis can be _______, ______ _______, or _________.

1. lymphatic 2. blood borne 3. idiopathic

While obtaining a patient's history, you learn that he has had a vasectomy. Which of the following scrotal pathologies is NOT more common in patients who have had a vasectomy? 1) Spermatocele 2) Epididymal cyst 3) Seminoma 4) Dilatation of the rete testis

3) Seminoma

A patient presents for a scrotal sonogram with a history of infertility. The testes appear normal bilaterally. Superior to the testes, multiple cystic structures are seen. The largest of these structures measures 4 mm. Color Doppler demonstrates flow within these structures and increased flow is seen when the patient is asked to perform the Valsalva maneuver. What is the likely diagnosis? 1) Spermatoceles 2) Epididymal cysts 3) Varicocele 4) Tubular ectasia of the rete testis

3) Varicocele

What is the most common correctable cause of male infertility? 1) Undescended testis 2) Spermatocele 3) Varicocele 4) Hydrocele

3) Varicocele

Normal measurements for testes:

3-5cm length, 2-3cm AP in adults; max size at puberty, shrink with age.

Full epididymis measurements:

3-6 cm in length.

A patient with a history of undescended testis is at an increased risk for which of the following? 1) Seminoma 2) Testicular torsion 3) Infertility 4) All of the above

4) All of the above

What is a collection of serous fluid located between the layers of the tunica vaginalis called? 1) Tunica albuginea cyst 2) Spermatocele 3) Ascites 4) Hydrocele

4) Hydrocele

What is the most common sonographic appearance of a malignant testicular mass? 1) Hyperechoic with diffuse calcifications 2) Complex mass with thick septations 3) Cystic mass with ring calcifications 4) Hypoechoic mass

4) Hypoechoic mass

You receive a request to evaluate a child with a history of undescended testis. Where are the majority of undescended testes located? 1) In the contralateral scrotum 2) In the flank area near the kidney 3) In the abdominal cavity 4) In the inguinal canal

4) In the inguinal canal

Which of the following statements regarding the testicular veins is FALSE? 1) The testis is drained by the veins of the pampiniform plexus 2) The veins of the pampiniform plexus empty into the testicular veins 3) The right testicular vein drains directly into the IVC 4) The left testicular vein drains directly into the IVC

4) The left testicular vein drains directly into the IVC

Surgery within __ hours of pain has a salvage rate of 80-100%

6 hrs

Surgery within __-__ hours after onset pain: salvage percentage is 70%

6-12 hours

_______ _______ = seen around testicle with Doppler**

Capsular arteries

_________ ______ = seen within testicle with Doppler**

Centripetal arteries

______ hydroceles, however, do not transilluminate, and this makes it difficult to distinguish a hydrocele, clinically, from a malignant process. Furthermore, the tense nature of the hydrocele may give the scrotum a rock- hard feeling which can mimic a tumor.

Chronic

_________________ is inflammation of both the epididymis and testicle.

Epididymoorchitis

At the onset of puberty, the anterior pituitary begins to secrete gonadotropic hormones called:

FSH and ICSH (interstitial cell stimulating hormone).

*MOST COMMON scrotal mass:*

Hydroceles

________ is inflammation of the testicle which can be secondary to epididymitis or which may be due to tumor or trauma.

Orchitis

What are the testes?

Paired oval glands; EXOCRINE AND ENDOCRINE GLANDS that produce sperm AND testosterone

______________ controls the development, growth, and maintenance of the male sex organs. It also stimulates bone growth, protein anabolism, sexual behavior, final maturation of sperm, and the development of male secondary sex characteristics. This hormone also stimulates descent of testes (7-8 months gestation).

Testosterone

Sonographic appearance of the testis:

The glandular elements of the testes have a fine homogeneous texture of medium level echogenicity, very similar to the thyroid gland texture.

What are the supporting structure of the testes?

The scrotum and spermatic cord

What does the tunica vaginalis cover?

The tunica vaginalis covers and surrounds the testes except on the posterior aspect in the region of the head of the epididymis

Sonographic appearance of the undescended testicle:

The undescended testicle is of similar echogenicity on sonographic exam as the normally positioned one, however, it may be smaller.

What may be present in chronic epididymitis:

a focal or generalized thickening of the epididymis is noted, the echogenicity may be increased, and calcifications may or may not be present

Clinical indicators of spermatoceles:

a palpable nodular area, the patient may be asymptomatic, or may present with a feeling of "heaviness". The patient may be tender to the touch, but this is not often the case.

The scrotum is:

a pouching of the abdominal wall consisting of loose skin and superficial fascia.

increased blood flow indicates:

acute epididymitis

Vasectomy procedure:

an incision is made in the scrotum, the ducts are located, and each is tied in two places. Then the portion between the ties is excised. Although sperm production continues in the testes, the sperm cannot reach the exterior because the ducts are cut.

Vessels, nerves, lymphatics and spermatic ducts travel through the area not covered by the tunica vaginalis, sometimes called the:

"bare area."

What is the Dartos tunic?

(also called just "Dartos"). This is a layer of smooth muscle fibers situated in the superficial fascia; the deep fibers help to form the septum of the scrotum

Inflammation of epididymis =

*Epididymitits*

___________: *MOST COMMON inflammation that occurs in scrotum (75%) and the MOST COMMON cause of acutely painful/enlarged scrotum.**

*Epididymitits*

*THE MAJOR ROLE OF US is to:*

*determine whether a mass is intra-testicular, or extra-testicular.*

The vast majority of intra-testicular lesions (95%) will be _________ tumors.

*malignant*

Various sonographic appearance of acute torsion:

- In some cases, the entire scrotal contents are abnormal in organization and texture, particularly when hemorrhage has occurred. - All layers of the scrotum seem involved and a thickened wall may be seen. - A reactive hydrocele is often present. - In addition, the acoustic texture of the glandular elements of the testes is usually abnormal. - This may mimic a testicular abscess. - In other cases of acute torsion the actual twisted vascular pedicle can be resolved. - The testicle is enlarged with increased or decreased echogenicity depending on whether it is congested or necrotic (decreased in early stages -- about 4 hours after torsion occurred).

Causes of torsion:

- Some testicles are anatomically predisposed because of inadequate connective tissue (developmental weakness/most of them - between 12 and 18 yrs) - can be caused by trauma as well.

Normal veins of the pampiniform plexus have a diameter between __-__ mm and they change very little or not at all when the patient is in the erect position, performs a Valsalva maneuver or with abdomen compression

1 and 2 mm

In young men, what is epididymitis most often caused by? 1) Sexually transmitted disease 2) Scrotal trauma 3) Torsion 4) Infertility

1) Sexually transmitted disease

A patient presents for a scrotal sonogram with a history of vasectomy and scrotal discomfort.Multiple cystic structures are seen in both testes along the mediastinum testis. Color Doppler does not demonstrate any flow in these cystic structures. What is the likely diagnosis? 1) Tubular ectasia of the rete testis 2) Bilateral spermatoceles 3) Simple intratesticular cysts 4) Bilateral seminoma

1) Tubular ectasia of the rete testis

Which of the following is the fibrous sheath that covers and protects the testis and also makes up the mediastinum testis? 1) Tunica abuginea 2) Tunica vaginalis 3) Tunica gubernaculum 4) Tunica parietalis

1) Tunica abuginea

Body and tail of epididymis measurements:

1-2 mm in diameter.

Vas defernse is about ____ ____ long (___ ____), and it ascends along the __________ border of the testis, penetrates the _______ ______, and enters the pelvic cavity where it loops over the side and down the ________ surface of the bladder.

1. 18 inches; 45 cm 2. posterior 3. inguinal canal 4. posterior

_____________ tumors are usually small, less than 1 cm in diameter, with homogeneous echogenicity _______ to or slighty _______ echogenic than that of testicular parenchyma.

1. Adenomatoid 2. similar to or slightly more

While performing a sonographic examination of the scrotum, you suspect a varicocele is present. What is the normal measurement of the veins in the pampiniform plexus? 1) Less than 1 mm 2) Less than 2 mm 3) Less than 5 mm 4) Less than 1 cm

2) Less than 2 mm

Dilatation of the seminiferous tubules is associated with epididymal cysts and spermatoceles and is referred to as tubular ectasia of the: 1) Mediastinum testis 2) Rete testis 3) Tunica vaginalis 4) Tunica albuginea

2) Rete testis

Which of the following is not located within the scrotum? 1) Testes 2) Seminal vesicles 3) Spermatic card 4) Epididymis

2) Seminal vesicles

Torsion represents only ___% of acute scrotal pathology in postpubertal males.

20%

After __ hrs there is a very slim chance of salvageability.

24 hours

Malignant conditions occur most frequently between the ages of:

25 and 35.

What is the most common cause of acute scrotal pain? 1) Testicular torsion 2) Testicular malignancy 3) Epididymitis and epididymo-orchitis 4) Scrotal hernia

3) Epididymitis and epididymo-orchitis

Which of the following is NOT part of the anatomical division of the epididymis? 1) Tail 2) Body 3) Neck 4) Head

3) Neck

A 42-year-old patient presents with a painless right scrotal mass. Sonographically, a 2.5-cm, irregular, hypoechoic mass is seen in the mid-right testis. Color Doppler demonstrates hyperemia. The remainder of the scrotum, including the scrotal wall, appears normal. What is the most likely diagnosis? 1) Isolated orchitis 2) Testicular abscess 3) Seminoma 4) Intratesticular varicocele

3) Seminoma

Normal head of epididymis thickness:

7-12 mm.

Sonographic technique for scanning scrotum:

7.5 or 10 MHz SHORT focus transducer, with or without water path.

Extra-testicular solid masses are usually _______ tumors arising from the epididymis, tunica albuginea or spermatic cord

benign

It may be difficult to distinguish a mass from normal testicular tissue, but with ______ ______ ______ it can be done close to 100% of the time

careful scanning techniques

MOST COMMONLY a _______ ______ scan is performed.

direct contact

The ductus epididymis becomes less convoluted, its diameter increases, and at this point, it is called the _______ (___) _______ or seminal duct.

ductus (vas) deferens; seminal duct

Within the tail or globus minor, the ductus epididymis continues as the:

ductus deferens.

Epididymis consists of tightly coiled tube called:

ductus epididymis.

The epididymis consists mostly of a tightly coiled tube called the:

ductus epididymis.

Other types of malignancies are:

embryonal cell carcinoma, teratoma, choriocarcinoma.

Color Doppler malignancies will show ___________ vascularity in tumor.

increased

A decrease in the size of the testes may be a cause of __________

infertility.

If focal orchitis is present, it cannot sonographically be distinguished from an _______ ________ unless serial exams are performed.

occult neoplasm

Sonographic appearance of varioceles:

one or more veins within the ductus deferens and spermatic cord is dilated and appears as serpiginous fluid areas along the posterior aspect of the scrotum in the region of the epididymis. There is usually little or no deformity of the glandular elements of the testis. Doppler can be used to identify venous flow, and color Doppler will show prominent veins with *increased flow with a valsalva maneuver if a varicocele is present.*

Causes of epidiymitis: .

organisms from infected urine, prostate, or seminal vesicles

Symptoms of acute epididymitis are:

pain, redness, fever, edema, and possibly burning on urination.

Sonographic imaging with color-flow Doppler is the diagnostic tool of choice to assess:

perfusion to the testes (torsion)

A reactive hydrocele in the presence of epididymitis cannot always be distinguished from:

peritesticular or testicular abscess.

Traveling with the ductus deferens as it ascends in the scrotum are the testicular artery, cremasteric artery and differential artery, autonomic nerves, veins that drain the testes, and lymphatics. These bilateral structures constitute the _______ ______, which are supporting structures for the testes.

spermatic cords

A __________ is another common scrotal mass and is a retention cyst of small tubules containing sperm.

spermatocele

Clinical signs of torsion:

sudden onset of severe pain which begins without warning, even when the patient is asleep. Nausea and vomiting may accompany the pain. In 24 - 48 hours, the pain usually disappears, indicating the testicle is dead. In newborns, painless swelling and redness may be the only apparent symptoms.

Clinical symptoms of malignancies include:

swelling, palpable lump, secondary hemorrhage.

The organs of the male reproductive system are the:

testes (male gonads) which produce sperm, a number of ducts that either store or transport sperm to the exterior, accessory glands that add secretions constituting the semen, and several supporting structures, including the penis.

The _______ _______ is a partial septum of the testes. It forms the support for the entering and exiting testicular vessels and ducts.

testis mediastinum

Cells of Leydig secrete ___________ which is the most important androgen.

testosterone

Decreased, diminished, or lack of blood flow is a strong indicator of:

torsion

A decrease in size of the testicles can follow:

torsion or trauma or may be a symptom of a pituitary tumor, endocrine disease, senility, schizophrenia, renal transplant, or chronic alcoholism.

Acute hydroceles will _____________

transilluminate.

Spermatoceles can be a result of:

trauma, or sequel to chronic epididymitis.

Some epidiymis may change due to _________ (enlarged and congested/hypoechoic or nonhomogeneous).

vasectomy

Male characteristics that appear at puberty:

wide shoulders, narrow hips, body hair patterns (pubic hair/axillary and chest hair), facial hair, and temporal hairline recession enlargement of thyroid cartilage deepens voice.

Linear array proves the advantage of:

wider Field of View.