Lange Review Ultrasonography Examination, 4th Edition

Answers and Explanations

At the end of each explained answer, there is a number combination in parentheses. The first number identifies the reference source; the second number or set of numbers indicates the page or pages on which the relevant information can be found.

1. (A) The most common location of a spermatocele is the head of the epididymis. A spermatocele is a retention cyst that may occur following vasectomy, scrotal surgery, or epididymitis. (5:748)

2. (D) Torsion is more common in children or teenage boys. It is a weakening in the attachment of the mesentery from the spermatic cord to the testicle. Clinically, the patient presents with sudden extreme pain in the scrotum. Treatment must occur within 5 or 6 hours of onset to save the testicle. The sonographic appearance varies according to the length of time that diagnosis is made. Acute torsion occurs within the first 24 hours. In the early stages, there is a decrease in the arterial flow to the testis. An enlarged epididymis and an enlarged hypoechoic testis are imaged. There may be thickening of the scrotal skin or the formation of a hydrocele. (4:333)

3. (B) In patients with uncomplicated acute epididymitis, there will be enlargement of the epididymal head or the entire epididymis. The epididymis has a decrease in echogenicity, and there may be increased blood flow with a reactive hydrocele. (3:413–415)

4. (C) The head of the epididymis is located superior to the testes. The rest of the epididymis courses along the posterior margin of the testicle inferiorly. (5:721, 722)

5. (C) The seminal vesicles are reservoirs for sperm and are located posterior to the urinary bladder. (3:408)

6. (A) A seminoma is a solid malignant mass of the testicles that is usually unilateral and appears hypoechoic on a sonographic examination. (4:338)

7. (B) Thyroiditis appears sonographically as a diffuse enlargement of the thyroid with a decrease in echogenicity. (4:279)

8. (E) Pheochromocytoma is a benign adrenal tumor of the medulla. It secretes both epinephrine and norepinephrine. (5:502, 503)

9. (A) The image is of a testicular tumor. The epididymis is enlarged in cases of testicular torsion and epididymitis. In cases of varicocele, there will be enlarged vessels, and a spermatocele produces a sonolucent lesion usually in the region near the head of the epididymis. The epididymis is normal on the image. (3:415, 421)

10. (E) Lymphadenopathy, leukemia, or acute scrotal pain may be a presenting symptom associated with a testicular tumor. (3:421, 423)

11. (D) The left renal vein. (3:410)

12. (A) The testicle may have anechoic areas, and the epididymis has a complex appearance. Associated findings include an enlarged epididymis and a reactive hydrocele. Spectral Doppler and color Doppler are used to evaluate whether the torsion is complete or incomplete. In cases of complete torsion, there will be no blood flow to the affected testicle. (4:333)

13. (E) Normal testicles have a homogeneous appearance. When performing color Doppler, the setting should be set as low as possible on the unaffected side and be compared with the affected side. Cryptorchidism is an undescended testicle; orchiectomy is removal of the testicle; and epididymitis is inflammation of the scrotum. (3:323)

14. (B) This sonogram demonstrates dilated vessels near the head of the epididymis. (4:329)

15. (A) A varicocele appears as tortuous vessels near the head of the epididymis, mostly occurring on the left. The reason varicoceles occur more on the left side is that the left testicular vein courses into the left renal vein, whereas the right testicular vein drains into the right spermatic vein. (4:329)

16. (E) An extratesticular cyst is documented on the sonogram. This is consistent with a spermatocele, which is a cyst in the epididymis containing spermatozoa. An epididymis cyst would have the same sonographic appearance. A varicocele (enlargement of the veins of the spermatic cord) is also extratesticular, but it is located on the posterior surface, more common of the left; and sonographically, it has a tubular shape. Seminoma is a malignant germ cell tumor within the testicle. (4:331)

17. (B) Normal head of the epididymis. (3:410)

18. (B) The arrow is pointing to the seminal vesicle, which is posterior to the bladder and superior to the prostate. (3:424)

19. (D) Varicocele is an enlargement of the veins of the pampiniform plexus, which course along the posterior aspect of the testicle and is more prominent on the left testicle. Venous dilatation occurs with an increase of pressure either by having the patient perform a Valsalva maneuver or by having the patient stand. Spermatocele and epididymal cysts are found in the epididymis. Cryptorchidism is another name for undescended testes. Mediastinum testis is found within the testis and connects the rete testis with the epididymis. (3:415)

20. (D) The two lobes of the thyroid are connected by the isthmus, which is anterior to the trachea. The common carotid is located lateral to the thyroid and the sternothyroid muscle is anterolateral to the thyroid. (4:272)

21. (A) A patient with a parathyroid adenoma may present with hypercalcemia and low serum levels of phosphate. (2:405)

22. (B) Posterior urethra valves is the most common cause of urethral obstruction in boys. The valves located in the posterior urethra obstruct the urethra. Dilatation of the urethra, hydroureter, and hydronephrosis may occur secondary to the obstruction. (5:606)