logging in or signing up Scrotal Ultrasound aSGuest42228 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2161 Category: Education License: All Rights Reserved Like it (7) Dislike it (0) Added: April 06, 2010 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: 1999deepak (9 month(s) ago) this is good 4 revision Saving..... Post Reply Close Saving..... Edit Comment Close By: muneer55 (14 month(s) ago) Can I please have a copy of this presentation. drmuneerjunejo@hotmail.com Saving..... Post Reply Close Saving..... Edit Comment Close By: drvikrampatil (14 month(s) ago) it would be great if you could send me the presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: fabbychix (15 month(s) ago) great.. Saving..... Post Reply Close Saving..... Edit Comment Close By: RadTD (16 month(s) ago) Great! Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Scrotal Ultrasound : Scrotal Ultrasound Read Chapter 19 Objectives : Objectives Differentiate intratesticular and extratesticular abnormalities. Differentiate intratesticular and extratesticular abnormalities. Describe the technique and protocol used in a scrotum ultrasound exam. Identify pathologic conditions of the scrotum. Recognize the normal sonographic structure patterns of the scrotum. Ultrasound is nearly 100% sensitive for evaluating the scrotum : Ultrasound is nearly 100% sensitive for evaluating the scrotum Sonographic Strengths : Sonographic Strengths Inexpensive Readily and rapidly available No ionizing radiation High-resolution gray scale examination Color Doppler evaluation Anatomy : Anatomy Tunica Vaginalis Tunica Albuginea Mesiastinum Scrotal Wall Anatomy : Anatomy Epididymis Ductus Epididymis Ductus Deferens Rete testis Lobules Pampiniform plexus Seminal vesicles Lab Values : Lab Values The following lab values are associated with certain testicular tumors: Beta-human chorionic gonadotropin: Choriocarcinoma Embryonal carcinoma Alpha-fetoprotein Yolk sac tumors Technique : Technique 7.5 – 12 MHz transducer Color & spectral Doppler Correctly labeled (rt. or lt.) Gain Light transducer pressure Avoid cold room Gloves Rolled towel for support Scanning Protocol - Longitudinal : Scanning Protocol - Longitudinal Medial aspect of testicle Midline of testicle with measurement Lateral aspect of testicle Epididymal head in relation to the testicle Scanning Protocol - Transverse : Scanning Protocol - Transverse Epididymal head Superior aspect of testicle Midportion of testicle with measurement Inferior aspect of testicle One image demonstrating both testis for comparison. Sonographic Appearance - Testicle : Sonographic Appearance - Testicle Homogeneous Medium to low level echoes Symmetry Sonographic Appearance - Epididymis : Sonographic Appearance - Epididymis Posterior and superior to the testicle 3 parts – head, body, tail Normally hyperechoic or isoechoic to testicle. Sagittal Plane : Sagittal Plane Pampiniform plexus appears as numerous linear, hypoechoic, slightly tortuous structures measuring 1 to 2 mm in diameter. Best demonstrates capsular and intratesticular arteries which radiate toward the mediastinum. Mediastinum seen as an echogenic line extending craniocaudally within the testis. Tranverse : Tranverse Veins and arteries are seen as hypoechoic, ovoid structures. Mediastinum appears as an ovoid, echogenic structure in the 3 or 9 o’clock positions. Common Causes of Lump With Pain : Common Causes of Lump With Pain Local injury Epididymitis Infection of scrotal sac Mumps Testicular torsion Common Causes of Lump Without Pain : Common Causes of Lump Without Pain Cancer Hydrocele Loop of bowel from hernia Varicocele Ouestions to Ask Patients With a Lump : Ouestions to Ask Patients With a Lump Time pattern? Quality? Location? Aggravating factors? Relieving factors? Testicular Torsion – Possible Causes : Testicular Torsion – Possible Causes Inadequate connective tissue within scrotum. Trauma, especially with significant swelling Incidence is higher in infancy and with the onset of puberty. Torsion – Signs & Symptoms : Torsion – Signs & Symptoms Sudden onset of pain in one testicle N/V Swelling Light headedness or fainting Blood in semen Tender, enlarged, inhomgeneous, and hypoechoic to contralateral testcle Elevation of affected testicle (Brunzel’s Sign) Torsion – Sonographic Appearance : Torsion – Sonographic Appearance Varies according to the severity and time from onset. Color Doppler is crucial in distinguishing this condition. Little or NO blood flow will be detected. Tortioned Testicleswww.ultrasound-images.com : Tortioned Testicleswww.ultrasound-images.com Tortioned Testicleswww.ultrasound-images.com : Tortioned Testicleswww.ultrasound-images.com Tortioned Testiclewww.ultrasound-images.com : Tortioned Testiclewww.ultrasound-images.com Epididymitis : Epididymitis Most Common cause of scrotal pain in post-pubescent men Most commonly caused by a lower urinary tract infection Can spread to testis (Orchitis) Abscess or necrosis may develop Clinically presents with fever, swollen and tender. Can be chronic or acute Epididymitis : Epididymitis Sonographically appears as enlarged, hypoechoic and hyperemic. Use the unaffected side for comparision. Ischemia may result from increased intratesticular pressure. Findings may be indistinguishable from chronic torsion or testicular neoplasm. EpididymitisPhillips : EpididymitisPhillips EpididymitisPhillips : EpididymitisPhillips EpididymitisPhillips : EpididymitisPhillips Epididymal Abscesswww.ultrasound-images.com : Epididymal Abscesswww.ultrasound-images.com Orchitis : Orchitis May be caused by numerous bacterial and viral infections (mumps most common viral). 15 to 20% of men who have mumps after puberty will develop orchitis. Develops in 2% to 20% of men with Brucellosis May occur as a manifestation of STD or prostate infection. Orchitis – Signs & Symptoms : Orchitis – Signs & Symptoms Scrotal swelling Tender and swollen groin area on affected side. Discharge from penis Ischemic Orchitiswww.ultrasound-images.com : Ischemic Orchitiswww.ultrasound-images.com Testicular Abscesswww.ultrasound-images.com : Testicular Abscesswww.ultrasound-images.com Crytorchidism : Crytorchidism The failure of one or both testicles to descend into scrotal sac. Approximately 30% of premature infants affected, 3% to 4% of term infants affected Majority are found in inguinal canal. Greater risk of becoming cancerous. Sonographically appears as an ovoid, hypoechoic, homogeneous mass in the inguinal canal. Usually mobil with pressure. Usually smaller than normal. Hydrocele : Hydrocele Also called Processus Vaginalis Common in new born infants Can be unilateral or bilateral Occurs between the viseral and parietal layers of tunica vaginalis 50% occur due to trauma Can occur secondary to infection, torsion, or neoplasm Hydrocele : Hydrocele Painless swollen testicle Feels like a water balloon Sonographically appears as a fluid collection anteriolateral to the testis. Gubernaculum can be seen as an echogenic band attaching the testis to the lower scrotal wall. Calcifications associated with hydroceles are known as “scrotal pearls” Hydrocelewww.ultrasound-images.com : Hydrocelewww.ultrasound-images.com Varicocele : Varicocele Caused by incompetent vein valves, leading to dilation of the pampiniform plexus. Develop slowly and may be assymptomatic Incidence is higher in men aged 15 to 25 years. Varicocele : Varicocele Clinically presents with visibly enlarged veins in the scrotum, painless lump with scrotal swelling, abnormally warm scrotum. Sonographically, the diameter of the veins in the pampiniform plexus dilate with the Valsalva maneuver. Increased blood flow also confirms varices (this differentiates varicocele from spermatocele) Infertility may be secondary Usually requires no treatment. Varicocelewww.ultrasound-images.com : Varicocelewww.ultrasound-images.com Spermatocele : Spermatocele Cystic areas within the small tubules that contain sperm. Most common location is the head of the epididymis. Fluid displaces the testis anteriorly rather than surrounds the testis as the hydrocele does. Painless and sonographically indistinguishable from an epididymal cyst. Scrotal Hernias : Scrotal Hernias Bowel protrudes through inguinal canal. Occur at any age and may be associated with heavy lifting. Extratesticular Clinically presents with persistent or intermittent scrotal mass, abdominal mass, or blood in stool. Sonographically appears as a complex structure with peristalsis in the scrotum. Scrotal Herniawww.ultrasound-images.com : Scrotal Herniawww.ultrasound-images.com Primary Neoplasms : Primary Neoplasms Extratesticular masses are usually benign. Intratesticular masses are considered malignant until proven otherwise. Testicular cancer is the most common neoplasm in males 15-35 years old. Testicular cancer is often curable. Testicular Cancer : Testicular Cancer Majority of patients present with a painless, unilateral testicular mass. 90% to 95% are germ cell origin. Treatment for any potentially malignant mass generally prompts surgical intervention. Seminoma is most common malignancy. (50%) Testicular Cancer : Testicular Cancer Mixed germ cell, embryonal, teratomatous and choriocarcinoma comprise the remainder. Sonographically can have a variety of appearances but are often focal and hypoechoic. Usually distort the testicular contour. Surrounding tissue and contralateral testicle appear normal. Metastases to testis is rare. Testicular Cancer- Predisposing Factors : Testicular Cancer- Predisposing Factors Undescended testicle Mumps Orchitis Inguinal hernia during childhood Previous testicular cancer on other side Seminomawww.ultrasound-images.com : Seminomawww.ultrasound-images.com Seminomawww.ultrasound-images.com : Seminomawww.ultrasound-images.com MicrolithiasisPhillips : MicrolithiasisPhillips Ruptured Testiclewww.ultrasound-images.com : Ruptured Testiclewww.ultrasound-images.com Epididymal Cystwww.ultrasound-images.com : Epididymal Cystwww.ultrasound-images.com You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Scrotal Ultrasound aSGuest42228 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2161 Category: Education License: All Rights Reserved Like it (7) Dislike it (0) Added: April 06, 2010 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: 1999deepak (9 month(s) ago) this is good 4 revision Saving..... Post Reply Close Saving..... Edit Comment Close By: muneer55 (14 month(s) ago) Can I please have a copy of this presentation. drmuneerjunejo@hotmail.com Saving..... Post Reply Close Saving..... Edit Comment Close By: drvikrampatil (14 month(s) ago) it would be great if you could send me the presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: fabbychix (15 month(s) ago) great.. Saving..... Post Reply Close Saving..... Edit Comment Close By: RadTD (16 month(s) ago) Great! Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Scrotal Ultrasound : Scrotal Ultrasound Read Chapter 19 Objectives : Objectives Differentiate intratesticular and extratesticular abnormalities. Differentiate intratesticular and extratesticular abnormalities. Describe the technique and protocol used in a scrotum ultrasound exam. Identify pathologic conditions of the scrotum. Recognize the normal sonographic structure patterns of the scrotum. Ultrasound is nearly 100% sensitive for evaluating the scrotum : Ultrasound is nearly 100% sensitive for evaluating the scrotum Sonographic Strengths : Sonographic Strengths Inexpensive Readily and rapidly available No ionizing radiation High-resolution gray scale examination Color Doppler evaluation Anatomy : Anatomy Tunica Vaginalis Tunica Albuginea Mesiastinum Scrotal Wall Anatomy : Anatomy Epididymis Ductus Epididymis Ductus Deferens Rete testis Lobules Pampiniform plexus Seminal vesicles Lab Values : Lab Values The following lab values are associated with certain testicular tumors: Beta-human chorionic gonadotropin: Choriocarcinoma Embryonal carcinoma Alpha-fetoprotein Yolk sac tumors Technique : Technique 7.5 – 12 MHz transducer Color & spectral Doppler Correctly labeled (rt. or lt.) Gain Light transducer pressure Avoid cold room Gloves Rolled towel for support Scanning Protocol - Longitudinal : Scanning Protocol - Longitudinal Medial aspect of testicle Midline of testicle with measurement Lateral aspect of testicle Epididymal head in relation to the testicle Scanning Protocol - Transverse : Scanning Protocol - Transverse Epididymal head Superior aspect of testicle Midportion of testicle with measurement Inferior aspect of testicle One image demonstrating both testis for comparison. Sonographic Appearance - Testicle : Sonographic Appearance - Testicle Homogeneous Medium to low level echoes Symmetry Sonographic Appearance - Epididymis : Sonographic Appearance - Epididymis Posterior and superior to the testicle 3 parts – head, body, tail Normally hyperechoic or isoechoic to testicle. Sagittal Plane : Sagittal Plane Pampiniform plexus appears as numerous linear, hypoechoic, slightly tortuous structures measuring 1 to 2 mm in diameter. Best demonstrates capsular and intratesticular arteries which radiate toward the mediastinum. Mediastinum seen as an echogenic line extending craniocaudally within the testis. Tranverse : Tranverse Veins and arteries are seen as hypoechoic, ovoid structures. Mediastinum appears as an ovoid, echogenic structure in the 3 or 9 o’clock positions. Common Causes of Lump With Pain : Common Causes of Lump With Pain Local injury Epididymitis Infection of scrotal sac Mumps Testicular torsion Common Causes of Lump Without Pain : Common Causes of Lump Without Pain Cancer Hydrocele Loop of bowel from hernia Varicocele Ouestions to Ask Patients With a Lump : Ouestions to Ask Patients With a Lump Time pattern? Quality? Location? Aggravating factors? Relieving factors? Testicular Torsion – Possible Causes : Testicular Torsion – Possible Causes Inadequate connective tissue within scrotum. Trauma, especially with significant swelling Incidence is higher in infancy and with the onset of puberty. Torsion – Signs & Symptoms : Torsion – Signs & Symptoms Sudden onset of pain in one testicle N/V Swelling Light headedness or fainting Blood in semen Tender, enlarged, inhomgeneous, and hypoechoic to contralateral testcle Elevation of affected testicle (Brunzel’s Sign) Torsion – Sonographic Appearance : Torsion – Sonographic Appearance Varies according to the severity and time from onset. Color Doppler is crucial in distinguishing this condition. Little or NO blood flow will be detected. Tortioned Testicleswww.ultrasound-images.com : Tortioned Testicleswww.ultrasound-images.com Tortioned Testicleswww.ultrasound-images.com : Tortioned Testicleswww.ultrasound-images.com Tortioned Testiclewww.ultrasound-images.com : Tortioned Testiclewww.ultrasound-images.com Epididymitis : Epididymitis Most Common cause of scrotal pain in post-pubescent men Most commonly caused by a lower urinary tract infection Can spread to testis (Orchitis) Abscess or necrosis may develop Clinically presents with fever, swollen and tender. Can be chronic or acute Epididymitis : Epididymitis Sonographically appears as enlarged, hypoechoic and hyperemic. Use the unaffected side for comparision. Ischemia may result from increased intratesticular pressure. Findings may be indistinguishable from chronic torsion or testicular neoplasm. EpididymitisPhillips : EpididymitisPhillips EpididymitisPhillips : EpididymitisPhillips EpididymitisPhillips : EpididymitisPhillips Epididymal Abscesswww.ultrasound-images.com : Epididymal Abscesswww.ultrasound-images.com Orchitis : Orchitis May be caused by numerous bacterial and viral infections (mumps most common viral). 15 to 20% of men who have mumps after puberty will develop orchitis. Develops in 2% to 20% of men with Brucellosis May occur as a manifestation of STD or prostate infection. Orchitis – Signs & Symptoms : Orchitis – Signs & Symptoms Scrotal swelling Tender and swollen groin area on affected side. Discharge from penis Ischemic Orchitiswww.ultrasound-images.com : Ischemic Orchitiswww.ultrasound-images.com Testicular Abscesswww.ultrasound-images.com : Testicular Abscesswww.ultrasound-images.com Crytorchidism : Crytorchidism The failure of one or both testicles to descend into scrotal sac. Approximately 30% of premature infants affected, 3% to 4% of term infants affected Majority are found in inguinal canal. Greater risk of becoming cancerous. Sonographically appears as an ovoid, hypoechoic, homogeneous mass in the inguinal canal. Usually mobil with pressure. Usually smaller than normal. Hydrocele : Hydrocele Also called Processus Vaginalis Common in new born infants Can be unilateral or bilateral Occurs between the viseral and parietal layers of tunica vaginalis 50% occur due to trauma Can occur secondary to infection, torsion, or neoplasm Hydrocele : Hydrocele Painless swollen testicle Feels like a water balloon Sonographically appears as a fluid collection anteriolateral to the testis. Gubernaculum can be seen as an echogenic band attaching the testis to the lower scrotal wall. Calcifications associated with hydroceles are known as “scrotal pearls” Hydrocelewww.ultrasound-images.com : Hydrocelewww.ultrasound-images.com Varicocele : Varicocele Caused by incompetent vein valves, leading to dilation of the pampiniform plexus. Develop slowly and may be assymptomatic Incidence is higher in men aged 15 to 25 years. Varicocele : Varicocele Clinically presents with visibly enlarged veins in the scrotum, painless lump with scrotal swelling, abnormally warm scrotum. Sonographically, the diameter of the veins in the pampiniform plexus dilate with the Valsalva maneuver. Increased blood flow also confirms varices (this differentiates varicocele from spermatocele) Infertility may be secondary Usually requires no treatment. Varicocelewww.ultrasound-images.com : Varicocelewww.ultrasound-images.com Spermatocele : Spermatocele Cystic areas within the small tubules that contain sperm. Most common location is the head of the epididymis. Fluid displaces the testis anteriorly rather than surrounds the testis as the hydrocele does. Painless and sonographically indistinguishable from an epididymal cyst. Scrotal Hernias : Scrotal Hernias Bowel protrudes through inguinal canal. Occur at any age and may be associated with heavy lifting. Extratesticular Clinically presents with persistent or intermittent scrotal mass, abdominal mass, or blood in stool. Sonographically appears as a complex structure with peristalsis in the scrotum. Scrotal Herniawww.ultrasound-images.com : Scrotal Herniawww.ultrasound-images.com Primary Neoplasms : Primary Neoplasms Extratesticular masses are usually benign. Intratesticular masses are considered malignant until proven otherwise. Testicular cancer is the most common neoplasm in males 15-35 years old. Testicular cancer is often curable. Testicular Cancer : Testicular Cancer Majority of patients present with a painless, unilateral testicular mass. 90% to 95% are germ cell origin. Treatment for any potentially malignant mass generally prompts surgical intervention. Seminoma is most common malignancy. (50%) Testicular Cancer : Testicular Cancer Mixed germ cell, embryonal, teratomatous and choriocarcinoma comprise the remainder. Sonographically can have a variety of appearances but are often focal and hypoechoic. Usually distort the testicular contour. Surrounding tissue and contralateral testicle appear normal. Metastases to testis is rare. Testicular Cancer- Predisposing Factors : Testicular Cancer- Predisposing Factors Undescended testicle Mumps Orchitis Inguinal hernia during childhood Previous testicular cancer on other side Seminomawww.ultrasound-images.com : Seminomawww.ultrasound-images.com Seminomawww.ultrasound-images.com : Seminomawww.ultrasound-images.com MicrolithiasisPhillips : MicrolithiasisPhillips Ruptured Testiclewww.ultrasound-images.com : Ruptured Testiclewww.ultrasound-images.com Epididymal Cystwww.ultrasound-images.com : Epididymal Cystwww.ultrasound-images.com