Pediatric Sonography- Scrotum & Testes

what are the testes formed by embryologically?

the mesenchymal duct

what is the prostate formed by embryologically?

urogenital sinus

failure of the testes to descend into the scrotum can result in what?

infertility

malignancy

the testes descend into the scrotum via the _________ _______

Inguinal canal

descent of the testicles occur between ____-____ weeks GA

25-32

the descent of the testicles in utero is dependant on the secretion of what?

androgens

if testicles are undescended postnatally, they usually descend within the first ___ months of life

3

which scrotal structures are not seen on neonates?

epididymis

mediastinum

neonate testicles measure ____-____ mm in diameter

7-10

the echogenic linear structure along the vertical axis of the testes represents which structure?

mediastinum

what term describes the congenital absence of both testicles?

anorchism

what term describes the congenital absence of 1 testicle?

monorchism

what term describes an accessory testicle?

polyorchism

Ectopic testes occur when the ___________ passes to an abnormal location and the testes follow it

gubernaculum

what is transverse testicular ectopia?

when both testicles are in the same hemiscrotum

undescended testicles are usually located where?

inguinal canal

what is the sonographic appearance of cryptochordism

smaller testis

testes located along the path of descent

higher echogenicity

can look like a lymph node

if cryptorchodism is found, what other exam should be performed?

renal ultrasound

what term describes a testicle that is fully descended but can move freely from its intrascrotal position to the groin?

retractile testicle

what causes a retractile testicle?

a hyperactive cremasteric reflex

what term describes a patient that has both ovarian and testicular tissue?

True hermaphroditism

what are the clinical presentations of true hermaphroditism in boys?

gynecomastia

cyclic hematuria cryptorchidism

what are the clinical presentations of true hermaphroditism in girls?

amenorrhea

what age has the highest incidence of testicular torsion?

infancy & adolescence

what are the 2 types of testicular torsion?

intravaginal

extravaginal

which type of testicular torsion is more common?

intravaginal

what term is used to describe torsion of the epididymis?

torsion of the mesorchium

extravaginal torsion occurs in what patient demographic more frequently?

neonates

intravaginal torsion occurs in what patient demographic more frequently?

adolescents

what causes extravaginal torsion?

a spermatic cord thats poorly fixed to the inguinal canal

what causes intravaginal torsion?

the tunica vaginalis completely surrounds testis and inserts high on the spermatic cord

which deformity is a predisposing factor for torsion?

bell-clapper deformity

what are the signs/symptoms of extravaginal torsion?

swollen/red scrotum

painless firm enlarged testicles

what are the signs/symptoms of intravaginal torsion?

sudden onset of scrotal pain

N & V

severely tender scrotum with swolleness & hyperemia

what treatment is required for intravaginal torsion?

immediate surgery

torsion surgery has a 100% salvage rate within ___ hrs of pain onset

6

what is the sonographic appearance of extravaginal torsion?

acute- heterogenous enlarged scrotum with hypo/hyper masses

chronic- normal or enlarged, peripheral calcifications

no colour flow through testes

what is the sonographic appearance of intravaginal torsion?

4-6 hrs: hypoechoic

24 hrs: heterogeneous from hemorrhage/infarction

Testicle is often TRV

Reactive hydrocele

Skin thickening

Enlarged, twisted spermatic cord

Hypoechoic epididymis

Acute epididymitis/epididymo-orchitis is most common in which patient demographic

pubertal boys

what are the signs/symptoms of acute epididymitis/epididymo-orchitis?

gradual onset of pain

fever

pyuria

what scrotal patho is seen in prepubertal boys infected with mumps?

mumps orchitis

what is the sonographic appearance of acute epididymitis/epididymo-orchitis?

Focal or diffuse enlargement epididymis with coarse echoes

Focal orchitis shows hypoechoic areas

Doppler - hyperemic

Reactive hydrocele

Skin thickening

what is the most common cause of acute scrotal pain in prepubertal boys

torsion of the appendages

torsion of the appendages occurs in boys aged ___-___

6-12

what is the clinical sign of torsion of the appendages?

blue dot sign

what is the sonographic appearance of torsion of the appendages?

Solid, ovoid mass with variable sized hypoechoic centre and hyperechoic rim

Adjacent to the superior aspects of the testis or epididymis

testicular trauma is usually caused by what?

sports injuries

what is the treatment for testicular rupture?

emergency surgery

what are the 2 peak incidences of contracting a testicular neoplasm?

children under 2.5

late adolescence

Children with cryptorchidism are ___-___ times more likely to develop a testicular neoplasm

30-50

what is a rare germ cell tumour affecting ages 15-35 that is associated with cryptorchism?

seminoma

what is the sonographic appearance of seminoma?

Hypoechoic masses

Heterogenous

Distorts testis if large

Vascular

what is the most common tumor in prepubertal children, seen primarily in 1-2 yrs old child, that causes high AFP?

yolk sac tumour

what is the clinical presentation of a yolk sac tumour?

painless scrotal mass

embryonal carcinoma usually occurs around what age?

adolescence

which type of scrotal malignancy has the worst prognosis?

choriocarcinoma

choriocarcinoma causes high ____

bhCG

teratomas affect children under ___ years old

4

what is the sonographic appearance of a teratoma?

Complex masses

Hypoechoic areas (serous fluid)

Hyperechoic areas (fat and calcification)

leydig tumours affect children aged ___-___

3-6

leydig tumours secrete what substance?

testosterone

sertoli tumours affect children that are ___ years old

1

sertoli tumours are hormone inactive, but secrete some _________

estrogen

what term describes an abnormal collection of serous fluid in the scrotal sac?

hydrocele

what is the sonographic appearance of a hydrocele?

Anechoic, well-demarcated

area with ↑ TT

what term describes blood in tunica vaginalis?

hematocele

what are the causes of hematocele?

surgery

trauma

bleeding disorders

malignancies

what is the sonographic appearance of hematocele?

fluid collection with debris septations

fluid-debris levels

what term describes dilated veins of pampiniform plexus?

varicocele

varicocele more commonly occurs on which side?

left side

what is the sonographic appearance of varicocele?

small, serpentine, anechoic structures, with flow on Doppler

inguinal hernias occur more commonly on which side?

right side

what is the sonographic appearance of an inguinal hernia?

bowel loops with air or fluid in scrotum

Normal testes

Herniated omentum

No peristaltis in incarcerated hernia

testicular microlithiasis occurs in healthy patients or patients with what conditions?

Down's syndrome

Cryptorchidism

Klinefelter's syndrome

what is the sonographic appearance of testicular microlithiasis?

appear as 1-3mm hyperechoic, non shadowing foci

what is a patho occuring in the epi head, consist of fluid, spermatazoa, and sediment?

spermatocele