Thyroid cont. and Scrotum for Final Pt 2

TI-RAD

Thyroid Imaging Reporting Data System

• Points-based system, standardized terminology, risk stratification, physicians discretion

Wider than tall points:

Taller than wide points:

0

3

Smooth margins:

Ill-defined:

Lobulated/irregular:

Extrathyroidal extension:

0

0

2

3

Cystic composition:

Spongiform:

Mixed Cystic and Solid:

Solid:

0

0

1

2

Anechoic:

Hyper/Isoechoic:

Hypoechoic:

Very Hypoechoic:

0

1

2

3

Comet-Tail:

Microcalcifications:

Peripheral/Rim calcifications:

Microcalcification:

0

1

2

3

0pt TR#

1 (No Bx)

2pts TR#

2 (No Bx)

3pts TR#

3

4-6pts TR#

4

7+ TR#

5

Parathyroid size:

5×3×1mm

Parathyroid Shape:

Small, flat, oval

Parathyroid is located __________ to thyroid

Posterior to thyroid

Parathyroid Hyperplasia

Enlargement or hyperfunction of parathyroid, enlargement of glands

Parathyroid Gland Adenoma

Superior: Adjacent to posterior aspect, mid portion of thyroid

Inferior: close proximal to caudal tip of thyroid

Parathyroid Adenoma shape

Football shaped

Parathyroid Carcinoma

1% of pt w/hyperparathyroidism have a carcinoma, small and irregular but will enlarge, firm/hard masses, increased serum calcium levels

Parathyroid Carcinoma USA

Large, irregular, lobulated, taller than wide, mets to regional nodes

Lymphadenopathy

A localized/generalized enlargement of the lymphnode

Lymphnode USA Normal

Oval in shape w/a symmetric, homogeneous, thin outer cortex and an echogenic central hilum, size does not exceed 1cm, color should be low to show flow entering hilum

Abnormal Lymphnode USA:

Varies in appearance, rounded/lobulated shape, loss of echogenic hilum, thick cortex, symmetric/asymmetric w/lobulated borders, increased vascularity, may present w/calcifications and more complex/cystic appearance, multiple

Thyroglossal Duct Cysts

Congenital anomaly, found midline, anterior to the trachea, 2-3cm, fusiform or spherical, remnant of tubular development of thyroid gland between base of tongue and hyoid bone

Brachial Cleft Cyst

Located laterally, a diverticulum that extends laterally from pharynx, or medially from neck, primarily cystic, may have debris, bilateral, occurs in older children/adults

Cystic Hygroma:

Congenital malformation of lymphatics, large cystic mass, lateral aspect of neck

Abscess of the neck

Can be anywhere, pain, swelling

Abscess of the neck USA

Fluid filled to echogenic, usually low level echoes w/irregular walls, can locate and drain under US guidance

Adenopathy

Enlarged lymphnodes

USA of Adenopathy

Low level echogenicity, well circumscribed, abnormal shape w/internal hilum, may be difficult to differentiate from inflammation

Most common primary scrotal infection:

Epididymitis

Most common cause of scrotal infections

UTI and STD’s

S/S of scrotal inflammation:

Scrotal pain, fever, urethral discharge, swelling

Most common scrotal pain in adults

Epididymo-Orchitis

During epididymal orchitis, the epi appears _________, hypoechoic, with ________ vascularity

enlarged; increased

Diffuse/Focal Orchitis appears enlarged, _______ echogenicity with increased ______

Focal may appear as a _____

enlarged; increased; mass

Hydrocele is seen with _________ and _______

torsion; trauma

Hydrocele is when fluid surrounds the __________

Testicle

Most common cause of painless scrotal swelling

Hydrocele

Hydrocele appears ______ or may have _____ and septations

anechoic; echoes

Pyocele is caused by rupture of _________ or an _________ _________

abscess; untreated infection

Contents within a pyocele include septations, __________, debris, use pt Hx to help diagnose

loculated

Hematocele is caused by ______

trauma

Hematocele is a collection of ________

blood

Acute appearance of a hematocele - ________ highly visible echoes

Chronic appearance of a hematocele - low-level echoes and _______

numerable; septations

Testicular rupture must be treated within ____ hours for high salvage

72

Sonographic findings of testicular rupture include an altered testicular pattern, tunica _________, ________ wall thickening

interruption; scrotal

Scrotal Hematoma appears ________, evolves to include ________ components

heterogeneous; fluid (complex)

Most common cause of acute scrotal pain in adolescents

Testicular torsion

Testicular torsion is due to twisting of the ________ and ______

testis; epi

Torsion is caused by the _______ deformity

bellclapper

In early findings of torsion it can appear _______, later on it can appear ______ and ________

Heterogeneous after ____hrs

normal; enlarged; hypoechoic; 24

Sonographic signs of testicular torsion include the ________ sign, reactive hydrocele, and ___ vascular flow

whirlpool; no

Surgery for torsion within 5-6hrs = _____% salvage rate

80-100

Epididymal cysts

Fluid-filled, anechoic structures in epi

Spermatoceles

Found in epi head, contain proteinaceous fluid and spermatozoa, seen post vasectomy

Tunica cysts

Located between tunica vaginalis and tunica albuginea, can appear complex

Most common extra-testicular cause for infertility

Varicocele

Varicocele is an abnormal condition of __________ plexus, which is common of the _____ side due to drainage angle

pampiniform; left

Varicocele USA

Bag of worms, dilated veins >2mm, increase with Valsalva maneuver

Tubular ectasia

Dilated tubes at rete testis; seen with spermatocele, 45yrs or older, honeycomb appearance

Intra-testicular cysts

Anechoic, near mediastinum, common in men >40, incidental

Microlithiasis

Tiny echogenic foci <3mm, associated with malignancy, non-shadowing

Malignant testicular tumors are most common in men ages ____ - ____, and more common in ____ men

15-35; white

Labs for malignant testicular tumors

Elevated hCG and AFP

95% of malignant testicular tumors are ______ cell tumors

germ

Most common testicular malignancy

Seminoma

Seminoma

Homogeneous, hypoechoic, well-defined borders, no calcifications

Embryonal cell carcinoma (2nd most common malignancy of testicle)

Heterogeneous, irregular testicle contour

Teratoma

Malignant, complex mass w/cystic and solid

Choriocarcinoma

Mixed appearance, irregular, often shows hemorrhage and necrosis

Mets to testes are most commonly from ________, ______ or rarely lung and colon

prostate; kidney

Lymphoma

Most common in men >1-7; appears bilateral or with focal areas, increased vascularity, hypoechoic lesions

Leukemia

More common in children, 2nd most common secondary mass in testicles

Cryptorchism

Testicle fails to descend; complications include cancer, torsion and infertility, mostly get stuck in abdomen or inguinal canal

Testicular ectopia

Cannot be repositioned, most common site = inguinal pouch

Anorchia

Absence of testicle, rare, most common in left

Polyorchidism

Testicular duplication, risk of malignancy and cryptorchism, hernias and torsion, more common in left

Sperm granuloma

Reaction to sperm, often post vasectomy appear as solid mass, hypoechoic, heterogeneous

Hernia of testicle/scrotum

When bowl or other contents herniate into scrotum

Hematoma of testicle

Associated with trauma, may be large and displace testes, appear heterogeneous, initially solid, become complex, avascular