Testicular Anatomy and Scrotal Conditions Quiz

Testicular Anatomy and Sonographic Findings

• Testes are symmetrical, oval-shaped glands in the scrotum; appear smooth, medium gray with fine echotexture sonographically.
• Epididymis is a 6-7 cm tubular structure, superior then posterolateral to the testis.
• Testicular arteries arise from abdominal aorta below renal arteries (both sides); venous drainage via pampiniform plexus veins.
• Scrotal rupture shows altered testicular parenchyma, tunica albuginea interruption, irregular contour, scrotal wall thickening, and hematocele.

Scrotal Conditions

• Epididymo-orchitis: Infection of epididymis and testis, often from lower urinary tract infection spreading via spermatic cord.
• Torsion: Abnormal testicular mobility within scrotum; most commonly caused by "bell clapper" deformity.
• Cysts: Benign fluid collections, usually extratesticular; Varicocele is dilated pampiniform plexus veins, usually due to incompetent valves.
• Hernias: Bowel, omentum, or other structures herniating into scrotum.
• Fluid Collections: Potential space between visceral/parietal tunica vaginalis layers for hydrocele, pyocele, hematocele formation.
• Hydrocele: Serous fluid; most common cause of painless swelling; often idiopathic or associated with epididymo-orchitis/torsion.
• Pyocele: Pus collection due to untreated infection or abscess rupture.
• Sperm Granulomas: Chronic inflammation from extravasated spermatozoa, frequently after vasectomy.

Rete Testis and Testicular Tumors

• Rete Testis: Located at testicular hilum (mediastinum); tubular ectasia is uncommon, benign condition often associated with spermatocele or other epididymal obstruction.
• Testicular Microlithiasis: Multiple bright, nonshadowing foci scattered throughout testis.
• Tumor Types: Extratesticular masses are usually benign; intratesticular masses are more often malignant. Germ cell and non-germ cell tumors are common classifications.
• Germ Cell Tumors: Associated with elevated human chorionic gonadotropin and alpha-fetoprotein.
• Seminomas: Homogeneous, hypoechoic masses with smooth borders.
• Embryonal Cell Carcinoma: Heterogeneous, less well-defined, potentially containing calcification, hemorrhage, fibrosis, or cystic areas.
• Teratomas: Heterogeneous, well-defined, possibly showing dense foci with acoustic shadowing.
• Malignant Lymphoma: Rare (1%-7%) secondary testicular tumor, often bilateral in men over 60.
• Cryptorchidism: Undescended testis (cannot be brought into scrotum); Orchiopexy is surgical treatment.