BREAST PENIS ANATOMY

What is the shape and echo pattern of a normal prostate?

Elliptical, chestnut-shaped, with smooth margins and a homogeneous internal echo pattern.

How is prostate volume calculated?

Using the formula for an ellipsoid.

What does a prostate/rectal ultrasound check?

The size, location and shape of the prostate and nearby structures, and signs of cancer or other conditions.

What is the penis composed of?

3 cylindrical masses of smooth muscle and erectile tissue enclosing vascular cavities.

Name the 3 masses of the penis and their positions.

2 corpora cavernosa (dorso-lateral) and 1 corpus spongiosum (midventral).

What does the corpus spongiosum contain?

The spongy urethra, the longest portion of the male urethra.

How is the penis scanned?

Postero-anteriorly, from the perineum.

What is the echo pattern of the corpora cavernosa?

A fine pattern of low-level internal echoes.

What is the echogenicity of the corpus spongiosum and the urethra?

The corpus spongiosum is hyperechoic; the urethra appears as an echogenic band.

What is the most common use of penile ultrasound?

Diagnostic workup of erectile dysfunction (ED).

Name other conditions assessed by penile ultrasound.

Peyronie's disease, high-flow priapism, penile fracture, penile urethral strictures, urethral stones, urethral diverticulae, masses involving deep tissues of the penis.

Define priapism.

Prolonged erection of the penis.

What is the echo pattern of the testis?

Homogeneous, finely granular, moderately echogenic (the scrotum slide describes it as hyperechogenic).

What are the parts of the epididymis?

Head, body and tail.

How does the epididymis compare with the testis in echogenicity?

It is more echogenic than the testis.

List the 7 indications for scrotal ultrasound.

Swelling, trauma, infection, pain, apparently absent testicle, haematospermia, infertility.

What patient preparation is needed for scrotal ultrasound?

None required.

How is the patient positioned for scrotal ultrasound?

Supine, penis lifted upwards toward the abdomen and covered with a towel, coupling agent applied liberally over the scrotum.

Which transducer is preferred for scrotum and testis?

7.5 MHz sector (especially for children); otherwise 5 MHz.

What are the average adult testis length, width, transverse and vertical diameters?

Length 5.0 cm, width 3.0 cm, transverse diameter 2.0 cm, vertical diameter 2.5 cm.

What separates the two testes in the scrotum?

A hyperechogenic septum.

Is a small amount of scrotal fluid normal?

Yes, small collections of fluid are often seen.

Which fibrous structure is seen in the testis on a longitudinal scan (Fig. 128a)?

The testicular mediastinum.

Name the 11 indications for gynaecological ultrasound.

Pelvic pain incl. dysmenorrhoea, pelvic mass, abnormal vaginal bleeding, abnormal vaginal discharge, amenorrhoea, IUCD presence and position, infertility, genital tract developmental abnormality, urinary or bladder symptoms, diffuse abdominal pain, follicular monitoring.

Define dysmenorrhoea.

Painful menstruation.

Define amenorrhoea.

Missed or absent menstrual cycle.

What patient preparation is needed for a pelvic scan?

A full bladder: give 4 or 5 glasses of fluid, examine after one hour, and do not allow the patient to micturate.

Which position and transducer are used for a pelvic scan?

Supine (may be rotated later); 3.5 MHz for adults.

How do you set the gain for a pelvic scan?

Place the transducer longitudinally over the full bladder and adjust the gain for the best image.

What is the scanning sequence for the female pelvis?

Longitudinal in the midline (umbilicus to pubic symphysis), then laterally left then right, angling to find the uterus, then transverse from just above the symphysis up to the umbilicus.

Where are transverse pelvic scans most useful?

Over the lower pelvis; they are less effective above the level of the uterus.

How do you find the ovaries if they are hard to see?

Turn the patient obliquely (30-40 degrees) and scan each ovary obliquely from the contralateral side of the abdomen.

What is needed for endovaginal ultrasound?

A specific long-handled transducer with a cover (condom) and coupling agent; specialized training is necessary.

What are the shape and echogenicity of the ovaries?

Ovoid/almond (round-to-oval) shape and hypoechoic.

Are normal ovaries easy to see transabdominally?

No, they are difficult to define with transabdominal ultrasound.

What affects the position of the ovaries?

The size and location of the uterus and the degree of bladder filling.

Which vessels is the ovary anterior to in Fig. 14-1?

The iliac vessels.

What are the divisions of the uterus?

Fundus, corpus, isthmus and cervix.

What affects uterine size and contour?

Age, hormonal status and parity.

Define parity.

The number of pregnancies a woman has had.

Define nulliparous.

A woman who has never given birth, by choice or any other reason.

What is the mean uterine size in a nulliparous female?

8 x 5 x 4 cm (length x width x AP diameter).

How does parity affect uterine size?

It may increase each dimension by more than 1 cm.

What is the sonographic appearance of the vagina?

A delicate double-walled band with an echogenic streak-like lumen.

Where is the vagina located?

Between the bladder and rectum.

What is the echogenicity of the vaginal walls?

Mid-level echoes, similar to the myometrium.

What does the midline echogenic stripe of the vagina represent?

The interface between the anterior and posterior vaginal walls.

What does the endometrial stripe represent?

The opposed surfaces of the endometrial layers.

Which transducer frequencies are used for genital organs?

3.5 or 5 MHz; 7.5-10 MHz occasionally for the penis and testis.

Which organs are scanned suprapubically with a full (not overdistended) bladder?

Uterus, ovaries, prostate and seminal vesicle.

In which planes are the genital organs surveyed?

Longitudinal and transverse sections.

Name the abnormal findings listed for the renal pelvis and ureter.

Pyelectasis, urinary stone colic, obstructive pyelocalyceal ectasia, urinary tract obstruction.

Name the abnormal findings listed for the bladder.

Diverticula, bladder wall thickening, obstructive pyelocalyceal ectasia, polypoid bladder tumors.

Name the intraluminal changes listed.

Ureterocele, sediment/pus/clotted blood, stones, foreign bodies.

How long does a breast ultrasound usually take?

Usually within 30 minutes.

What might you hear during a Doppler breast study?

Pulse-like sounds that change in pitch as blood flow is monitored and measured.

What two things must be labelled on a breast ultrasound image?

Breast side (right or left) and clock position.

Which scan planes are used for breast ultrasound?

Transverse, longitudinal and radial.

What does "Lt Breast 6:00 7 CM FN Rad" mean?

Left breast, 6 o'clock position, 7 cm from the nipple, radial scan plane.