Sonography Module: Men's Health Notes

Sonography Module: Men's Health

• Topics Covered:
  • Scrotal Ultrasound
  • Prostate Ultrasound

Anatomy of the Testes

• Scrotum: Continuation of the abdominal wall, divided by the scrotal septum into two sacs, each containing a testis and epididymis.

• Key Structures:

  • Tunica Vaginalis: Potential space containing fluid, preventing friction between scrotal structures.
  • Tunica Albuginea: Dense connective tissue encasing each testis, reflected into the testis to form the mediastinum testis.

Testicular Components

• Ductus deferens: Transports sperm from epididymis.
• Testicular Artery & Veins: Supply blood to testes.
• Seminiferous Tubules: Site of sperm production.
• Epididymis: Stores and matures sperm.

Spermatic Cord

• Contains the testicular, deferential, and cremasteric arteries, along with veins forming the pampiniform plexus, lymphatics, and nerves.

Vascular Supply of Testes

• Arteries: Testicular arteries arise from the abdominal aorta.
• Veins: Right testicular vein drains into the inferior vena cava; left testicular vein drains into the left renal vein.

Ultrasound in Testicular Evaluation

• Primary Imaging Modality:
  • Nearly 100% sensitivity and specificity for detecting testicular conditions.
  • Differentiates solid from cystic lesions and evaluates testicular perfusion.

Indications for Testicular Ultrasound

• Evaluation of scrotal masses, detection of tumors, acute scrotum, and localization of undescended testes.

Performing Scrotal Ultrasound

• Preparation: Obtain clinical history, review previous exams, and explain the procedure to the patient.
• Technique: Use a high-resolution linear array transducer (7.5-17.0 MHz), patient in supine position.
  • Light probe pressure, warm gel application.

Measurements to Document

• Size, shape, echogenicity of testis and epididymis, vascularity using color Doppler.

Testicular Pathology

• Common Conditions:
  • Cryptorchidism: Failure of testis to descend; increased risk of cancer.
  • Cysts: May be simple anechoic lesions with clear fluid.
  • Torsion: Sudden pain, requires emergency attention to salvage the testis.
  • Hydrocele: Accumulation of serous fluid in tunica vaginalis, commonly causing painless swelling.
  • Varicocele: Dilated veins may indicate incompetence in testicular veins, often related to infertility.
  • Epididymitis and Orchitis: Inflammation often due to infection; treated with antibiotics.
  • Carcinoma and Seminoma: Most common malignancy in young men; often asymptomatic initially, requiring careful evaluation via ultrasound.

Imaging Findings on Ultrasound

1. Hydrocele: Anechoic collection, may see low-level echoes from fibrin or cholesterol.
2. Torsion: Testicular swelling, decreased echogenicity, and possible absence of blood flow.
3. Varicocele: Dilated veins appearing tortuous; may require Valsalva maneuver for assessment.
4. Tumors: Seminoma appears as a homogeneous, solid, hypoechoic lesion.

Prostate Anatomy and Ultrasound

• Prostate Zones: Divided into peripheral, transition, central, and anterior fibromuscular zones.

Prostate Evaluation and Indications

• Benign Prostate Hypertrophy (BPH): Detected via transabdominal ultrasound; volume assessed using the formula: length x width x height x 0.52.
• TRUS (Transrectal Ultrasound): Used for detecting lesions and guiding biopsies, especially for suspected prostate cancer.

Prostate Pathology

• Cancer Detection: Most common cancer in men over 50; ultrasound can detect abnormalities but has a limited detection rate; TRUS biopsy more effective.
• Emerging Technologies: MicroUS offers higher resolution imaging which can enhance detection rates.

Prepare for the Exam

Key Points to Review

• Anatomy of male reproductive organs and structures.
• Common testicular pathologies and their ultrasound findings.
• Understanding preparation and techniques for ultrasound procedures.
• Contrast imaging findings, recognizing normal vs. pathological conditions.