Chapter 24: The Scrotum

what are the reasons to perform testicular scan?

palpable mass, swelling, pain, varicocele for infertility, cancer

if a patient has a varicocele, how would it appear?

“bag of worms”

if there is cancer of the scrotum, it is usually ___.

intratesticular

testicle has turned on itself and cut off blood supply

torsion

each testicle should be symmetrical in size and measure ___ in length.

3-5 cm

each testicle should be symmetrical in size and should measure ___ in width.

2-4 cm

each testicle should be symmetrical in size and measure ___ in height.

3 cm

what are the two layers of the tunica vaginalis?

parietal and visceral

space between the visceral and parietal layers of the tunica vaginalis where things can accumulate

cavity

how long is the epididymis?

6-7 cm

what is the largest part of the epididymis?

the head

what is the normal measurement of the head of the epididymis?

6-15 mm

the epididymal head is typically found off to the ___ side of the testicle.

lateral

the tail of the epididymis comes around to meet the ___.

ductus deferens

the epididymis should be ____ with the testicle.

isoechoic

the testis is covered by dense, fibrous tissue termed ____.

tunica albuginea

the posterior aspecto f tunica albuginea reflects into the testis to form a vertical septum known as the ___.

mediastinum testis

the mediastinum testis appears as a(n) ___.

echogenic/hyperechoic line

what lines the inner walls of the scrotum, covering each testis and epididymis?

tunica vaginalis

the inner lining of the scrotal wall

parietal layer

layer of the tunica vaginalis that surrounds the testis and epididymis

visceral layer

the scrotum has a small bare area where the tubules come out and is located ____.

posterior

at the site of the bare area of the scrotum, the testicle is _____.

is against the scrotal wall

at the site of the bare area of the scrotum, the testicle is against the scrotal wall, preventing ___.

torsion

what travels through the bare area of the scrotum?

blood vessels, lymphatics, nerves, spermatic ducts

____ form in the space between the layers of the tunica vaginalis.

hydroceles

the Leydig cells produce ___.

testosterone

the Sertoli cells produce ___.

androgen binding protein

___ stimulates the Leydig cells to produce testosterone.

lutenizing hormone (LH)

____ stimulates the Sertoli cells to produce the androgen binding protein.

follicle-stimulating hormone (FSH)

when the androgen binding protein binds to testosterone, it promotes ___.

sperm production

what causes sperm production to begin by telling the brain to release gonadotropins?

the pituitary gland

the ___ stores sperm and is the location of sperm maturation.

epididymis

creates fluid called semen

seminal vesicle

vas deferens meets the ____.

seminal vesicle

the seminal vesicle meets the ____.

ejaculatory duct

the ejaculatory duct is part of the ____.

prostate

the ejaculatory joins with the ___.

urethra

the vas deferens loops around the ____ and joins the seminal vesicles.

bladder

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

spermatic cord

the spermatic cord extends from the scrotum through the ____ and ____.

inguinal canal and internal inguinal rings to pelvis

the spermatic cord suspends the ____.

testis in the scrotum

the vesicular artery branches from the ____.

internal iliac artery

the testicular artery comes off of the ___ portion of the abdominal aorta.

anterior

the testicular artery comes off of the anterior portion of the ___.

abdominal aorta

what supplies the epididymis and vas deferns?

deferential artery

the cremasteric artery branches from the ____.

external iliac artery

the cremasteric artery perfuses the…

scrotal wall and muscles

the left testicular vein drains into the ___.

left renal vein

the right testicular vein drains ____.

directly back into the IVC

part of the spermatic cord that is taking blood away and back to the IVC

pampiniform plexus

the vascular supply of the scrotum on spectral doppler should show ____ flow.

low resistance

the ___ perfuses the testicle.

testicular artery

the cremasteric artery perfuses the ___ border (the scrotal wall/muscles).

lateral

perfuses the central portion of the testicle

centripetal artery

perfuses the capsule of the testicle

capsular artery

the capsular artery is a branch of the ___.

testicular artery

continuous flow represents ____.

vein

what is the patient position for a testicular scan?

supine, penis positioned on abdomen and covered with towel, rolled towel placed between thighs or placing legs closer together to support the scrotum

when scanning the scrotum, apply generous amount of _____ to the scrotum.

warmed gel

scrotal scanning uses a ___ probe.

high frequency, linear

the linear probe used for scrotal scanning is a frequency of…

10-14 MHz

for a testicular scan, it is always a ___ exam.

bilateral

which side is used as comparison when scanning the testicle?

asymptomatic side is used as comparison for the symptomatic side

___, ___, and ____ of each testis is evaluated.

size, echogenicity, and structure

testicular parenchyma should be…

uniform with an equal echogenicity between sides

if the virtual convex sector is used to see all of the testicle, it will _____.

decrease lateral resolution, increase FOV

hemiscrotum means…

one side

hydrocele = ___ fluid

anechoic

what could irregular testicular contour represent?

testicular rupture

if testicular rupture is caught soon enough, what percentage of the testicle could be salvaged?

90%

contain blood

hematoceles

how does testicular rupture appear on ultrasound?

hypoechoic region, irregular borders, avascular flow, possible rupture of tunica albugenia

how does epididymitis/epididymo-orchitis appear clinically?

swelling, redness, skin warmth/thickening (edema), possible urethral discharge, elevated WBCs

inflammation of the epididymis

epididymitis

infection of the epididymis and testis

epididymo-orchitis

epididymo-orchitis most commonly results from…

the spread of a lower urinary tract infection via the spermatic cord

epididymitis starts in the ___.

tail

how does epididymitis appear on ultrasound?

enlarged, hypoechoic, hyperemic flow

if orchitis becomes severe enough, the inflammation can ____ the amount of flow and start to have ____ flow.

decrease; reversal

testicle torses and cuts off blood supply

testicular torsion

bell clapper anomaly, think ___.

testicular torsion

what is the bell clapper anomaly?

testicle and epididymis is suspended in the scrotal sac by a thin stalk rather than broad base, increasing the risk of torsion

testicular torsion is a ____.

surgical emergency

if testicular torsion is caught within 5-6 hours… ____ salvage.

80-100%

if testicular torsion is caught within 6-12 hours… ____ salvage.

70%

if testicular torsion is caught within >12 hours… ____ salvage.

20%

in cases of testicular torsion, ___ is cut off first and then ___.

venous doppler, artery flow

how does testicular torsion appear on ultrasound?

hypoechoic, avascular, possible presence of a hydrocele

sign that forms when the spermatic cord is seen turned on itself

whirlpool sign

the whirlpool sign is seen ____ of the time when torsion is present.

96%

epididymal cysts are usually in the ___.

head

spermatoceles are usually a fluid collection in the ___.

efferent ductules

abnormal dilation of the veins of the pampiniform plexus

varicocele

what is done to see varicoceles?

valsava maneuvers

in cases of scrotal hernias, most of the time ____ is what protrudes.

bowel

how do scrotal hernias appear on ultrasounds?

hyperechoic borders, contents within

testicular cysts are fluid collections within the ___.

rete testis

testicular cysts are normally ___.

incidental findings

tiny, hyperechoic calcifications within the testicle; usually associated with malignancy

microlithiasis