An Accumulation of Pus in a Body Cavity, Such As the Scrotum

Male reproductive :

Definition of pyocele:

An accumulation of pus in a body cavity, such as the scrotum.

Hydrocele:

•Accumulation of fluid between the layers of the tunica vaginalis

Causes

  : congenital or acquired:

  Inflammatory-granulomas, abcess, orchitis, epididymitis

  Vascular- hematoma, infarction

  Neoplastic- benign tumors (Leydig cell)

  -malignant germ cell tumors

  •If idiopathic, the presence or repair of this lesion is generally

  not associated with reduced fertility.

•Lack of controlled studies to support this statement

Symptoms

Usually the only indication of a hydrocele is a painless swelling of one or both testicles. Adult men with a hydrocele may experience discomfort from the heaviness of a swollen scrotum. Sometimes, the swollen testicle may be smaller in the morning and larger later in the day

Radiographic features

Ultrasound

Ultrasound is the first modality usually used to evaluate hydroceles. It presents as a simple fluid collection surrounding the testits

Testicular torsion

is a condition in which a testicle becomes twisted around the spermatic cord. This cord delivers blood to the testes and contains the channel that sends sperm to the penis.

The most common predisposing factor for testicular torsion is so-called bell clapper deformity). In bell clapper deformity, an abnormal insertion of the tunica vaginalis allows the testis wide mobility

Radiology :

Color Doppler imaging of testicular torsion demonstrates a complete absence of blood flow within the testis

Clinical presentation :

·  Sudden onset of severe unilateral scrotal pain followed by inguinal and/or scrotal swelling

·  Patients rarely report voiding difficulties or painful urination.

·  Nausea or vomiting

·  Lightheadedness

Ovarian torsion

is a condition in which a Fallopian tube becomes twisted inside the abdomen

Clinical presentation:

·  Sudden onset (commonly during exercise or other agitating movement) of severe, unilateral lower abdominal pain that worsens intermittently over many hours.

·  The pain usually is localized over the involved side, often radiating to the back, pelvis, or thigh.

·  Tenderness in the lower abdominal area.

·  A mildfever

·  Tachycardia.

Radiology :

Ultrasound is the diagnostic modality of choice for detecting torsion. The absence of blood flow within the ovary on Doppler exam is a useful finding in establishing the diagnosis

Benign Prostatic Hypertrophy:

is extremely common in elderly men and is a major cause of outflow obstruction. Although the term prostatomegaly is often usedinterchangeably, strictly speaking prostatomegaly may refer to any cause of prostatic enlargement

Signs and symptoms

When the prostate enlarges, it may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptoms:

·  Urinary frequency

·  Urinary urgency

·  Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream

·  Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination

·  Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder

·  Decreased force of stream - The subjective loss of force of the urinary stream over time

·  Dribbling - The loss of small amounts of urine due to a poor urinary stream

Ultrasound

Ultrasound has become the standard first line investigation after the urologist's finger. Typically there is an increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone).

Post micturition residual volume is typically elevated

Female reproductive :

Hystreosalpingography

is a contrast media study demonstrating uterus , uterine and fallopian tube .A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with injection material .

Case : 20 yrs old female with history of appendicitis, what test will you do to asses her fertility ? " inflammation will cause adhesions which may obstruct one of the fallopian tubes."

criteria summary :

pelvic ring centered

cannula/ catheter visible within cervix

opacified uterine cavity and tubes visible

contrast media seen in peritoneum > indicate for (patent fallopian tube )

optimum density and contrast

Poly cystic ovarian syndrome :

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

·  Acne.

·  Weight gain and trouble losing weight.

·  Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.

·  Thinning hair on the scalp.

·  Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.

·  Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).

·  Depression

Radiographic features

Ultrasound

Sonographic features include

Ovaries

·  may show sonographic features of polycystic ovaries

o  bilateral enlarged ovarieswith multiple small follicles :50%

§  increased ovarian size (> 10 cc)

§  12 or more follicles measuring 2 - 9 mm

§  follicles of similar size

§  peripheral location of follicles : which can give a string of pearl appearance

§  hyperechoic central stroma

§  the ovarian outline may be slightly irregular ref

·  hypo-echoic ovary without individual cysts :25%

·  normal ovaries :25%

Normal Endometrium thickness:

In pre menopausal "reproductive age" patients it significantly varies according to the stage of the menstrual cycle:

·  during menstruation:2 - 4mm

·  early proliferative phase (day 6 - 14 ) :5 - 7mm

·  late proliferative - pre ovulatory phase : up to11mm

·  secretory phase :7 - 16mm

In post menopausal patients it Will depend on the use of use of hormonal therapy

·  if on no medication:< 5mm

·  if on hormonal therapy:8 - 15mm upper limit

Uterine Fibroid

They are benign growths, arising from the muscular wall of the uterus. Their origin is thought to be the muscle in the walls of uterine blood vessels.

-A uterine leiomyoma (uterine fibroid) is a benign tumour of myometrial (smooth muscle) origin. It is the most common solid benign uterine neoplasm

Fibroids are also called by other names such as: Myoma, Leiomyoma, Leiomyomata and Fibromyoma

Signs and symptoms

Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, infertility.There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus

•  Epidemiology

They occur in ~ 20 - 30% of women of reproductive age 1 and are particularly common in the African population

•  Types:

a number of locations within or out of the uterus :

•  Within the uterus

1.  intra-mural leiomyoma: most common

2.  sub-serosal leiomyoma

3.  sub-mucosal leiomyoma : least common : ~ 10 - 15 %

They can also undergo several types of degeneration

•  hyaline degeneration, cystic degeneration

•  myxoid degeneration, red - carneous

•  extra uterine pelvic leiomyomas7

Pelvic ultrasound

•  ultrasound is used to diagnose the presence and monitor the growth of fibroids

•  uncomplicated leiomyomas are usually hypo-echoic.

•  calcification is seen as echogenic foci with shadowing

•  cystic areas of necrosis / degeneration may be seen

CT

•  on CT images, fibroids are usually of soft tissue density but may exhibit coarse peripheral or central calcification

•  theymay distort the usually smooth uterine contour

•  enhancement pattern is variable

Pelvic MRI

•  Signal characteristics are variable, and include:

T1 :

–  non-degenerated fibroids and calcification appear as low to intermediate signal intensity compared with the normal myometrium

T2 :

–  non-degenerated fibroids and calcification appear as low signal intensity

–  as they are usually hypervascular, flow voids are often observed around them10

–  fibroids that have undergone cystic degeneration / necrosis can have a variable appearance, usually appearing high signal on T2 sequences.

T1 C+ (Gd) :

–  variable enhancement is seen with contrast administration