Scrotum Study Guide

What is the average size of testicles (length, width and height)?

Length 4 cm

Width 3cm

Height/AP 3cm

Seen as a hyperechoic line within the testis, supports vessels and ducts coursing within the testis.

Mediastinum testes

The epididymis is composed of a ___, ___ and ___. 

Head, body and tail

The epididymis lies how to the testis?

Lie along the posterolateral surface of the testis

What carries sperm from the epididymis up into the pelvic cavity to the seminal vesicles?

Vas deferens (ductus deferens)

What is the main blood supply to the testicles that branches off the aorta inferior to the renal arteries?

Testicular artery

What venous network drains the testes and joins to form the testicular veins?

Pampiniform plexus of veins

The spermatic cord contains

The Vas Deferens, Testicular arteries, Pampiniform Plexus of veins, Lymphatics, and Nerves

In patient preparation for a scrotal sonogram, the patient should be instructed to remove all clothing from the

waist down

What should have pulsed Doppler applied to them as part of the scrotal ultrasound protocol?

Testicular artery and testicular vein

The tunica vaginalis and tunica albuginea are not usually seen unless the patient has a

Hydrocele (fluid collection between the layers of the tunica vaginalis)

Cryptorchidism

refers to a testicle that fails to descend into the scrotum from the pelvis, through the inguinal canal.

80% of patients with cryptorchidism have testicles found in the

inguinal canal

Orchiopexy

surgical correction of cryporchidism

If surgery is not performed to correct an undescended testicle at an early age, what 3 things are the testis at a greater risk for?

Infertility (due to warm environment of the abdomen), developing testicular cancer, testicular torsion

Anorchia

absence of one or both testes

Polyorchidism

refers to having more than two testicles

Bilateral anorchia

absence of both testis

Epididymitis

inflammation of the epididymis

Epididymitis is the most common cause of

scrotal pain and tenderness.

Describe the sonographic appearance of epididymitis: (3 characteristics

: Enlargement of the epididymis ( especially the head), Hypoechoic and hypervascular (hyperemia)

Focal orchitis cannot be sonographically distinguished from?

A tumor

Elevated white blood cell count (leukocytosis) and a fever can be good clinical clues that the patient may have

Orchitis

A collection of blood within the scrotal sac is called a

Hematocele or hematoma

Appearance of hematoma/hematoceles vary with?

Age of injuiry

Hematocele/hematomas can occur due to 

trauma, surgery, torsion or tumor

Fracture of the testicle or testicular rupture due to trauma is a

surgical emergency.

Surgery within ___ hours of injury causing rupture can save 90% of the affected testicle

72 hours

Testicular torsion

results when the testis and the epididymis twist within the scrotum, cutting off the vascular supply within the spermatic cord.

Bell Clapper Deformity

the most common cause of testicular torsion.

With torsion there will be lack of flow in the ____ but normal flow in the _____

testicle, epididymis

indicated with chronic torsion.

Increased extratesticular flow

Hydrocele is a

collection of fluid between the layers of the tunica vaginalis.

Hyrdrocele is the most common cause of

painless scrotal swelling

It is normal to have how many mL of serous fluid in the scrotal sac?

1-2 mL

Pyocele

pus in the scrotal sac

Pyocele is caused by

abscess rupture between the layers of the tunica vaginalis.

Varicocele

an abnormal dilation of the pampiniform plexus of veins, and is most common on the left side

Describe the sonographic appearance of a varicocele:

Tortuous tubular anechoic structures outside the testicle in the scrotal sac.

A scrotal hernia results in

bowel herniating through the inguinal canal into the scrotum

How is a scrotal hernia usually diagnosed? (3 possible symptoms)

Clinically with an enlarged scrotum, abdominal pain, and possible blood in stool.

Less than __% of all solid scrotal masses are benign

5%

Dermoid cysts also known as Teratoma contain

Fat, teeth, hair, cartilage and possibly bone

Microlithiasis

multiple tiny calcifications scattered though the testis that are associated with tumor, sterility and cryptorchidism.

The majority of intratesticular lesions are

malignant

Testicular cancer is typically a young man’s disease, with a peak incidence at age’s

15- 35 years old

Seminoma

the most common germ cell tumor and has the best prognosis of testicular malignancies.

Embryonal cell carcinoma

is associated with increased Beta-HCG and is more aggressive than seminoma. It accounts for 25% of all testicular tumors.

The Yolk sac/endodermal sinus tumor is the most common germ cell tumor found in

infants

The Yolk sac tumor is associated with increased

Alphafetoprotein (AFP)

Teratomas in children are usually?

Benign

Teratomas in adults are usually?

malignant

Lymphoma affects

men between the ages of 60-80 years old

Lymphoma is

the most common bilateral testicular tumor.

What percent of all testicular tumors are germ cell tumors and are malignant?

95%

Only what can make the diagnosis of a tumor being malignant vs. benign?

tissue samples

Most physicians will perform a ______ when a solid mass is found within the testis.

orchiectomy

If metastasis to the testicles occurs the primary is usually

prostate or renal

What are 2 symptoms associated with malignant testicular masses?

Acute scrotal pain (10-50%) or a painless palpable scrotal mass

List the pathway of the sperm from the scrotum (6 total structures):

Semineferous tubules, tubuli recti, rete testis, efferent ductules, ductus epididymis, vas deferens