Left testicular venogram. This image shows a left testicular varicocele before embolization. Note: radiographs of varicoceles should be avoided to restrict radiation exposure.http://emedicine.medscape.com/article/382288-imaging
Showing posts with label varicocele. Show all posts
Showing posts with label varicocele. Show all posts
Monday, July 19, 2010
Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.http://emedicine.medscape.com/article/382288-imaging
reporting of varicocele
Ultrasonographic findings in varicoceles include the following:
1-Tortuous anechoic tubular structures are demonstrated adjacent to the testis.
2-With the patient in an upright position, the diameter of the dominant vein at the inguinal canal measures more than 2.5 mm and is associated with an increase in diameter of at least 1 mm during a Valsalva maneuver.
3-Varicoceles can be small to very large, with some enlarged vessels as large as 8 mm in diameter.
4-Varicoceles can be found anywhere in the scrotum (ie, medial, lateral, anterior, posterior, or inferior to the testis).
5-Color Doppler ultrasonographic imaging can be helpful in differentiating venous channels from epidermoid cysts or spermatoceles when doubt exists.
6-Bidirectional Doppler ultrasonography performed with the patient in the upright position with quiet respiration shows a shunt type of flow in 86% of patients in whom insufficient distal valves allow spontaneous and continuous reflux from the ISV into the cremasteric vein and the vein of the vas deferens.
7-Bidirectional Doppler ultrasonography performed with the patient in the upright position with quiet respiration shows a stop type of flow in 14% patients in whom intact valves allow only sporadic reflux from the spermatic vein into the pampiniform plexus with a Valsalva maneuver.
8-Doppler ultrasonography can be used to grade venous reflux as static (grade I), intermittent (grade II), or continuous (grade III) .
9-Effective sclerotherapy is indicated when venous dilatation resolves and the overall diameter of the veins decreases.
10-Intratesticular varicoceles may appear as a vague hypoechoic area in the testis. They appear tubular or oval shaped and usually lie near the mediastinum testis.
http://emedicine.medscape.com/article/382288-imaging
1-Tortuous anechoic tubular structures are demonstrated adjacent to the testis.
2-With the patient in an upright position, the diameter of the dominant vein at the inguinal canal measures more than 2.5 mm and is associated with an increase in diameter of at least 1 mm during a Valsalva maneuver.
3-Varicoceles can be small to very large, with some enlarged vessels as large as 8 mm in diameter.
4-Varicoceles can be found anywhere in the scrotum (ie, medial, lateral, anterior, posterior, or inferior to the testis).
5-Color Doppler ultrasonographic imaging can be helpful in differentiating venous channels from epidermoid cysts or spermatoceles when doubt exists.
6-Bidirectional Doppler ultrasonography performed with the patient in the upright position with quiet respiration shows a shunt type of flow in 86% of patients in whom insufficient distal valves allow spontaneous and continuous reflux from the ISV into the cremasteric vein and the vein of the vas deferens.
7-Bidirectional Doppler ultrasonography performed with the patient in the upright position with quiet respiration shows a stop type of flow in 14% patients in whom intact valves allow only sporadic reflux from the spermatic vein into the pampiniform plexus with a Valsalva maneuver.
8-Doppler ultrasonography can be used to grade venous reflux as static (grade I), intermittent (grade II), or continuous (grade III) .
9-Effective sclerotherapy is indicated when venous dilatation resolves and the overall diameter of the veins decreases.
10-Intratesticular varicoceles may appear as a vague hypoechoic area in the testis. They appear tubular or oval shaped and usually lie near the mediastinum testis.
http://emedicine.medscape.com/article/382288-imaging
varicocele
Transverse ultrasonography scan through the left testicle. This image shows several cystic structures (2.4-4 mm in diameter) behind the testis. Color flow Doppler image demonstrates flow within these cystic structures (not shown).http://emedicine.medscape.com/article/382288-imaging
varicocele
Line diagram of a typical bidirectional Doppler recording of a stop-type varicocele (red) in which flow is stopped by a competent valve in the pampiniform plexus above the level of communicating veins. The shunt-type of varicocele is depicted in blue. Because the valves in the pampiniform plexus contiguous to the testicular veins are incompetent or absent, venous flow is shunted via communicating veins into orthograde draining veins; these are shown to represent deferential and cremasteric veins at contrast venography.http://emedicine.medscape.com/article/382288-overview
varicocele
Upper image: Longitudinal sonogram through the pampiniform plexus of the left testis. The image shows several anechoic tubes. Lower image: The application of color Doppler imaging in the same patient shows bidirectional flow within the anechoic tubes.http://emedicine.medscape.com/article/382288-overview
varicocele
Longitudinal sonogram through the left testicle. This image shows several large anechoic tubes (2.4-6 mm in diameter) lying behind the upper and middle poles of the testicle. The diameter of these tubes increased by 1.5-2 mm with a Valsalva maneuver (not shown). T = testicle; v = varicocele.http://emedicine.medscape.com/article/382288-overview
varicocele
With Doppler ultrasonography, 2 types of retrograde flow in varicoceles have been described. These include the shunt-type varicocele and the stop-type varicocele (see Image below and Image 6 in Multimedia).10 The shunt-type varicocele occurs in 86% of patients and is associated with diminished sperm quality as well as with a medium to large varicocele. The stop-type varicocele involves reflux, which is only brief, and the sperm quality is normal and associated with a subclinical varicocele. Shunt-type Doppler flow occurs because insufficient distal valves allow spontaneous and continuous reflux from the internal spermatic vein into the cremasteric vein and the vein of the vas deferens via collateral vessels. The stop type of flow, also known as the pressure type, occurs in patients with intact intrascrotal valves. This type allows only a brief period of reflux from the spermatic vein into the pampiniform plexus when a Valsalva maneuver is performed.
Friday, June 11, 2010
Left varicocele in a 15-year-old boy. (a) Longitudinal US scan of the left hemiscrotum shows multiple anechoic structures (arrows) in the supratesticular region and extending behind the upper pole of the testis (T). (b) Color Doppler image shows that the anechoic structures are vascular. (c) Pulsed-wave Doppler image shows a venous waveform with increased flow during the Valsalva maneuver (arrow).
A varicocele is the abnormal dilation and tortuosity of the veins in the pampiniform plexus that run along the spermatic cord into the scrotum. The spermatic cord provides nourishment through the blood vessels and contains nerves and lymph glands as well as the vas deferens. Varicoceles are reported to be found in 15% of all males. They are found to be the cause of infertility in 30-40% of the cases. The varicoceles develop when a defective valve in the vein allows the normal one-way flow of blood to back up into the abdomen. Blood then flows from the abdomen into the scrotum where a hostile environment for sperm development is created. Most varicoceles develop slowly and do not show symptoms. Some are large and visible as twisting veins in the scrotal sac. These veins disappear when lying down and the valsalva maneuver (bear down or cough) is used to demonstrated their filling distention.
They are more common on the left side, but do also occur bilaterally. The right internal spermatic vein drains directly into the inferior vena cava, whereas the left internal spermatic vein drains into the left renal vein at a 90-degree angle. This angle prevents the formation of a valve. As a result, 85-99% of the varicoceles are left-sided and only 1% are bilateral.
Varicoceles may cause infertility because they are associated with low sperm counts and decreased mobility. Sonographically they appear as an extratesticular collection of tortuous tubular structures.
http://www.blogger.com/www.gehealthcare.com/.../cme_scrotal.html
They are more common on the left side, but do also occur bilaterally. The right internal spermatic vein drains directly into the inferior vena cava, whereas the left internal spermatic vein drains into the left renal vein at a 90-degree angle. This angle prevents the formation of a valve. As a result, 85-99% of the varicoceles are left-sided and only 1% are bilateral.
Varicoceles may cause infertility because they are associated with low sperm counts and decreased mobility. Sonographically they appear as an extratesticular collection of tortuous tubular structures.
http://www.blogger.com/www.gehealthcare.com/.../cme_scrotal.html
Subscribe to:
Posts (Atom)
