Medical Quiz on Male Reproductive Anatomy

Scrotal Sonography Study Guide

• Testicle Size: Average size is 3-5cm in length, 2-4cm in width, and 3cm in height.
• Mediastinum Testes: Appears as a hyperechoic line; supports vessels and ducts within the testicle.
• Epididymis: Composed of head, body, and tail; located along the posterolateral surface of the testicle.
• Sperm Transport: Vas deferens carries sperm from epididymis to seminal vesicles.
• Testicular Artery: Major blood supply to the testicles; branches off the aorta inferior to the renal arteries.
• Venous Drainage: Pampiniform plexus of veins drains the testes and joins to form the testicular veins.
• Spermatic Cord Contents: Vas deferens, testicular arteries, pampiniform plexus of veins, lymphatics, nerves.
• Patient Preparation: Remove all clothing from the waist down prior to a scrotal sonogram.
• Doppler Imaging: Pulsed Doppler should be applied to the testicular artery and vein during scrotal ultrasound.
• Tunica Vaginalis: Fluid collection (hydrocele) may occur between layers of the tunica vaginalis but normally not visualized.
• Cryptorchidism: Testicle that fails to descend into the scrotum; 80% found in inguinal canal.
• Surgical Correction: Orchidopexy corrects cryptorchidism.
• Testicular Cancer Risk Factors & Infertility: Undescended testes are at increased risk for infertility and testicular cancer, due to warmer abdominal temperatures.
• Absence of One or Both Testes: Anorchia is the absence of one or both testes; Polyorchidism is having more than two testes.
• Epididymitis: Inflammation of the epididymis; most common cause of scrotal pain and tenderness.
• Sonographic Appearance of Epididymitis: Enlarged and hypoechoic epididymis with hyperemia.
• Focal Orchitis: Clinically indistinguishable from a tumor; elevated white blood cell count and fever are useful diagnostic tools.
• Hematocele/Hematoma: Blood collection within the scrotal sac; appearance varies based on injury type.
• Testicular Fracture/Rupture: Surgical emergency; 90% success rate with surgery within 72 hours.
• Testicular Torsion: Twisting of the testis within the scrotum; cutting off blood supply. Bell-clapper deformity is a common cause.
• Lack of Testis Flow: With torsion, there is lack of flow in the testicle but normal flow in the epididymis.
• Hydrocele: Fluid collection between tunica vaginalis layers; the most common cause of painless scrotal swelling.
• Pyocele: Pus in the scrotal sac; usually from rupture of an abscess in tunica vaginalis.
• Varicocele: Enlarged and tortuous pampiniform plexus of veins; usually on the left side.
• Sonographic Appearance of Varicocele: Tortuous, tubular, anechoic structures outside the testicle.
• Scrotal Hernia: Bowel herniating through the inguinal canal into the scrotum; Diagnosis aided by clinical inspection revealing abdominal pain or a palpable mass in conjunction with a scrotal mass.
• Benign Scrotal Masses: Less than 5% of all solid scrotal masses are benign.
• Microlithiasis: Multiple tiny calcifications within the testis; associated with tumor, sterility, and cryptorchidism.
• Malignant Intratesticular Lesions: Majority of intratesticular lesions are malignant.
• Testicular Cancer: Typically occurs in young men (15-35 years old).
• Seminoma: Most common germ cell testicular tumor; generally has a good prognosis.
• Embryonal Cell Carcinoma: Associated with elevated Beta-HCG levels; more aggressive than seminoma.
• Yolk Sac/Endodermal Sinus Tumor: Most common germ cell tumor in infants.
• Teratoma: Usually benign in children, malignant in adults.
• Lymphoma: Bilateral testicular tumor, frequently found in men over 60.
• Malignant Testicular Tumors: 95% of all testicular tumors are malignant; tissue sampling required for diagnosis.
• Surgical Intervention: Orchiectomy for solid testicular masses, often when diagnosis of malignancy is suspected.
• Metastasis: If metastasis of primary is present, such as prostrate or kidney, then that is most likely the cause of the scrotal pain or mass.
• Scrotal Pain & Palpable Mass: 2 most common symptoms of malignant testicular masses (acute scrotal pain and painless palpable scrotal mass)
• Sperm Pathway: Seminiferous tubules, tubuli recti, rete testis, efferent ductules, epididymis, vas deferens.