Transcript Testicular Ultrasound

Testicular
Ultrasound
Alexis P Langsfeld MD
St Luke’s-Roosevelt Emergency Department
Ultrasound Division
Male Anatomy
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Testes are oval shaped inside scrotum
Average size 4 x 3 x 2.5
10-19 gms
Surrounded by tunica vaginalis
Tunica albuginea separates lobes within
the testes
Epididymis tail forms vas deferens
Male Anatomy
Testicular Anatomy
Vascular Supply
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Arterial flow from aorta by testicular artery
Deferential and cremasteric arteries supply
extra testicular components, collaterals to
testes
Venous flow via testicular vein
Technique
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Reassurance
Analgesia
Warm Gel
Frog leg
Towel under scrotum and over penis
Unaffected testes first
Technique
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High frequency probe
Color and Spectral Doppler
Spectral allows differentiation between
arterial and venous Flow
Venous flow is compromised first
Technique
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B-mode 2 views
View full testes with color flow
Identify blood flow around epididymis
Identify vascular pulse
Color-flow doppler to assess for venous vs.
arterial flow.
Venous flow is affected first in early
vascular insufficiency
Sonographic Appearance
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Homogenous, similar to liver
Minimal low flow throughout
Epididymis superior to testes
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Extra testicular structure
more ecchogenic
Appendix testes superior aspect of testes
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normally covered by epididymal head
Normal Testicular Exam
QuickTime™ and a
decompressor
are needed to see this picture.
Identify
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Testicle
Epididymis
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Head
Body
Tail
Arterial Flow
Venous Flow
Views
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Longitudinal and cross section
Indications
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Testicular pain
Testicular mass
Testicular Trauma
Differential Diagnosis
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Epididymitis
Orchitis
Trauma
Torsion
Varicoceale/ Hydroceal
Hernia
Epididymitis
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Most common cause of ED presentation for
scrotal pain
Infection and inflammation within the epididymis
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GC/ Chlamydia < 35
E-Coli >35
Gradual onset
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Poor historians
Pain threshold
Epididymitis
QuickTime™ and a
decompressor
are needed to see this picture.
Epididymitis
QuickTime™ and a
decompressor
are needed to see this picture.
Hydrocele
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Fluid around testes
Result from communication w/ abdominal
cavity
Often congenital
My be result of trauma, infection,neoplasm,
or torsion
Hydrocele
Varicocele
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Vessels in scrotum due to structural defect
“Bag of worms”
Can cause infertility by keeping testes at
higher heat
Gradual onset
varicocele
Vacicocele
Hernia
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Bowel contents fall through abdominal wall
defect into scrotum
Can become incarcerated/ torse
Inflammation can cause vessel
compression
Gradual onset
Mass
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Generally slow growing
Non-Acute
Hydrocele / Varicocele
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Generally soft & non-tender
Neoplasm
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Firm
Risk of hemorrhage
Testicular Cancer
Trauma
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Swelling and pain after direct trauma
Laceration, Hemorrhage, Contusion,
Capsular rupture, Torsion
Poor physical exam
Ultrasound evaluation Necessary
Torsion
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To Be discussed at later lecture
Epididymitis vs. Torsion
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Epididimitis
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Enlarged
Hypoechoic
Increased Vascularity
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Torsion
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Enlarged
Hypoechoic
Decreased vascularity
Epididymitis vs. Torsion
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20% overlap in symptoms
Difficult to differentiate with swelling and
tenderness
Different treatment plans
Appendix Testes Torsion
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To be discussed at later Lecture
Conclusion
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Image in 2 views
Use color to asses blood flow
Use doppler to quantify blood flow
Take the testicles seriously
Thank You
Resa Lewis for Images
Ultrasound Division