Testicles

• Normal beatis


  Has a homogeneous medium-level echo feature
• Testicle


  • Surrounded by a fibrous capsule, the tunica albuginea
  • Multiple septations (septula) arise from the tunica albuginea to form the mediastinum testis which is sonographically seen as an hyperechoic linear band extending longitudinally within the testis
  • Septa are given off from the mediastinum testis which radiate toward the surface of the testes and are attached to the tunica albuginea
• Seminiferous tubules


  1. Septula form wedge-shaped compartments that contain the seminiferous tubules

  2. Seminiferous tubules converge to form the tubuli recti
• Tubuli recti


  Connect the seminiferous tubules to the rete testis
• Male reproductive anatomy


  • Seminiferous tubules
  • Tunica albuginea
  • Septula
  • Mediastinum testis
  • Tubuli recti
  • Rete testis
  • Efferent ductules
  • Ductus epididymis
  • Vas deferens
  • Testicular artery
  • Pampiniform
  • Epididymis
  • Appendix testis
  • Appendix epididymis
  • Dartos
  • Scrotal raphe
  • Tunica vaginalis
• Rete testis


  An anastomosing network of delicate tubules located in the hilum of the testis that carries sperm to the epididymis
• Efferent ductules


  Carry the seminal fluid from the rete testis to the epididymis
• Epididymis


  • Composed of a head, body and tail
  • Head (globus major) is located adjacent to the superior pole of the testis and is the largest part where the efferent ductules converge to form a single convoluted duct (ductus epididymis)
  • Tail (globus minor) forms an acute angle and courses cephalad as the vas deferens
• Appendix testis


  A remnant of the Mullerian duct, a small ovoid structure located beneath the head of the epididymis
• Appendix epididymis


  Representing a detached efferent duct, a small stalk projecting off the epididymis
• Dartos


  A layer of muscle bars, lying beneath the scrotal skin and dividing the scrotum into two chambers
• Scrotal raphe


  The division of the two scrotal chambers
• Tunica vaginalis


  • The visceral layer covers the testis and epididymis, the parietal layer lines the scrotal chamber
• Testicular arteries


  • Capsular artery
  • Centripetal artery
  • Cremasteric artery
  • Deferential artery
• Seminoma


  The most common germ cell tumor type, radiosensitive and chemosensitive resulting in the most favorable prognosis
• Nonseminomatous germ cell tumors

  • Embryonal carcinoma
  • Teratomas
  • Yolk sac tumors (Endodermal sinus tumors)
  • Choriocarcinomas
• Mixed germ cell tumor


  A tumor with both seminomatous and nonseminomatous elements
• Leydig cell tumor


  A stromal (non-germ cell) testicular tumor that may produce testosterone resulting in precocious puberty or estrogen resulting in feminizing symptoms
• Tunica albuginea cyst


  A benign cyst normally located near the mediastinum testis and probably originating from the rete testis
• Epidermoid cyst


  A benign tumor of germ cell origin, a well-circumscribed solid tumor lying beneath the tunica albuginea filled with cheesy-white keratin
• Testicular abscess


  Usually a complication of epididymo-orchitis, presenting with an enlarged testis containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas
• Scrotal calcifications


  May be located within the testis or between the layers of the tunica vaginalis
• Testicular microlithiasis


  Frequently seen sonographically, the clinical significance is not well understood
• Testicular infarct


  An uncommon event typically with an undetermined cause, presenting as a triangular-shaped avascular intratesticular lesion
• Hydrocele


  Serous fluid that accumulates within the tunica vaginalis, either congenital or acquired
• Hematocele


  Blood filling the scrotal chamber associated with trauma
• Varicocele


  Dilation of the pampiniform venous plexus draining the testis, 90% occur on the left side
• Chronically acquired or secondary hydroceles

  Usually occur in men older than 40 years, may be idiopathic or the result of trauma, torsion, neoplasms, epididymite or archits
• Hydrocele


  • Low-level echoes from Sbrin or cholesterol crys tais may be visualized within the hydrocele
  • A hematocele is seen when blood fills the scrotal chamber associated with trauma
• Varicocele


  A dilation of the parpiniam venous plexus of the testcolor were which drain the testicle
• 90% of varicoceles are on the left side, due to the length of the left lasticular vein as drns into the left renal veis
• Varicocele


  • Varicoceles should distend when a patient is standing, with Visawa, or with abdominal compression
  • Varicoceles may produce aching pain when the individual has been standing for an extended period of time or heavy ting
• There is an association between varicoceles and infertility, but it is difficult to be certain if a varicocele is the cause of infertaty
• Unilateral scrotal pain may be the result of testicular torsion, epididymitis or varicocele
• Varicoceles are the most common correctable cause of male infertate
• Scrotal (Indirect Inguinal) Hernia


  Result from bowel protruding through the inguinal canal into the bunica vaginals of the
• The presence of peristalsis confirms the diagnosis of small inguinal hernias
• Extratesticular Tumors


  Usually involve the epididymis, the most common extratesticular tumor is the adenomatoid tumor
• Spermatoceles (Epididymal Cysts)


  Cystic masses of the epididymis that result from dilatation of the epididymal tubules, more common than epididymal cysts, filled with thick milky fluid containing spermatozoa
• Tubular ectasia of the rete testis

  Dilated testicular mediastinal tubules, a benign condition thought to result from partial or complete obliteration of the efferent ducts, often bilateral and frequently associated with spermatoceles, more common in men over 55