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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 339
3. When scanning the fetus, the first thing to do is
a) determine the focal zone.
b) take a BPD measurement.
c) decide the plane of view.
d) determine fetal presentation.
4. The intradecidual sign
a) describes an abnormal early intrauterine pregnancy.
b) describes the gestational sac’s location within the endometrial
cavity.
c) describes an early intrauterine pregnancy adjacent to the
endometrial cavity.
d) occurs the eighth gestational week.
5. An intrauterine pregnancy can be confirmed before visualization of
the yolk sac by identifying the
a) fluid-filled chorionic cavity.
b) double bleb sign.
c) developing chorionic villi.
d) double sac sign.
6. When the yolk sac, embryonic disk, and developing amniotic
membrane are visualized together it is described as the
a) fluid-filled chorionic cavity.
b) double bleb sign.
c) developing chorionic villi.
d) double sac sign.
7. A tail-like appendage is often identified at the site of the embryo’s
rump. With development it
a) becomes part of the umbilical cord.
b) regresses.
c) becomes part of the iliac wings of the bony pelvis.
d) becomes the lower segment of the sacral portion of the spine.
8. Between the twelfth and sixteenth gestational weeks, the amniotic
cavity has enlarged enough to
a) obtain a mean sac diameter measurement.
b) obliterate the yolk sac.
c) obliterate the chorionic cavity.
d) separate the yolk sac and the embryo.
9. When the umbilical cord enters the fetus
a) the umbilical artery courses cephalad to join portal circula-
tion and the umbilical veins run along each side of the urinary
bladder.
b) it joins the portal vein.
c) the umbilical vein courses cephalad to join portal circulation and
the umbilical arteries run along each side of the urinary bladder.
d) it merges into one vessel.
340 PART IV Pelvic Scanning Protocols
10. Male gender can be established from the early second trimester by
identifying the
a) penis.
b) urethra.
c) scrotum.
d) hydrocele.
11. The BPD can be measured
a) through a single plane of section that demonstrates a symmetri-
cal view of the third ventricle, thalami, cavum septum pellu-
cidum, and tentorium.
b) during the fourth gestational week.
c) through any plane of section that demonstrates a symmetrical
view of the short axes of the third ventricle and thalami.
d) during the third gestational week.
12. The abdominal circumference (AC) is measured through a single
plane of section that demonstrates where the
a) left branch of the portal vein and both kidneys are visualized.
b) umbilical arteries and the left and right portal veins are continu-
ous with one another.
c) right branch of the portal vein and the liver are visualized.
d) umbilical vein branches and the left and right portal veins are
continuous with one another.
13. Normal gut herniation should not be seen after the ______ GA
week.
a) twentieth.
b) twelfth.
c) tenth.
d) sixteenth.
14. Placenta previa can be ruled out if the placenta is _______ cm from
the internal os.
a) 1.5
b) 3
c) 2
d) 5
15. If an embryo is not visualized within the gestational sac, the GA in
weeks can be determined by measuring the mean sac diameter and
adding ____ to it.
a) 1.5
b) 3
c) 2
d) 5
16. A yolk sac is considered abnormal if it is larger than ____ mm.
a) 3
b) 6
c) 2
d) 7
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 341
17. As a trimester progresses, the crown rump length and amniotic sac
diameter increase ___ mm a day.
a) 1
b) 3
c) 1.5
d) 5
18. The circular structure visualized between 4 and 10 weeks that supplies nutrition to the developing embryo is the ___________.
a) yolk sac
b) disk
c) amnion
d) morula
19. For long bone measurements of the fetus, calipers are placed at the
a) cartilage on the superior end and the bone-cartilage interface at
the inferior end.
b) bone-cartilage interface.
c) cartilaginous ends of the bone.
d) cartilage on the inferior end and the bone-cartilage interface at
the superior end.
20. Lateral ventricle width is normal up to ____ mm.
a) 11
b) 7
c) 10
d) 5
Urogenital diaphragm
Testis
Urinary bladder
Symphysis pubis
Prostate gland
Urethra
Penis
Ureter
Seminal vesicle
Ejaculatory duct
Rectum
Scrotum
Epididymis
Ductus deferens
Male Pelvis
Bulbourethral gland
CHAPTER 14
Male Pelvis Scanning Protocol
for the Prostate Gland, Scrotum,
and Penis
Betty Bates Tempkin
Key Words
Buck’s fascia
Central zone
Corpora cavernosa
Corpus spongiosum
Ductus epididymis
Ejaculatory ducts
Epididymis
Interlobar septa
Median raphe
Mediastinum testis
Perineum
Peripheral zone
Prostate gland
Prostatic urethra
Retroperitoneal
Scrotal sacs
Scrotum
Seminal vesicles
Seminiferous tubules
Spermatic cords
Testicles
Transition zone
Tunica albuginea
Urethra
Vas deferens ducts
Verumontanum
Objectives
At the end of this chapter, you will be able to:
• Define the key words.
• Distinguish the sonographic appearance of the anatomy of the
male pelvis and the terms used to describe it.
• Describe the transabdominal transducer options for scanning
male pelvis anatomy.
• List the suggested patient positions (and options) when scanning
male pelvis anatomy.
• Describe the patient prep for male pelvis studies.
• Name the survey steps and explain how to evaluate the entire
length, width, and depth of the prostate gland, scrotum, and
penis.
• Name the transducer options for endorectal scanning.
• List the scanning planes and image orientations for endorectal
scanning.
• List the suggested patient position (and options) for endorectal
scanning.
• Describe the patient prep for endorectal scanning.
• Explain the order and exact locations to take representative
images of the prostate gland, scrotum, and penis.
• Answer the review questions at the end of the chapter.
343
344 PART IV Pelvic Scanning Protocols
Overview
The male pelvis contains the urinary bladder, a portion of the ureters, musculature, vasculature, and the genitourinary system, which
includes the prostate gland, seminal vesicles, scrotum, testicles, and
penis.
The emphasis of this scanning protocol chapter is the genitourinary system. As part of reproduction, the male genitourinary tract
provides a means to perpetuate the species. The spermatozoa are
manufactured in the testes; the ductal system stores and helps propel
the sperm during ejaculation via the penis; the alkaline secretions
from the prostate gland and seminal vesicles help the sperm survive
to complete the process of reproduction.
Anatomy
Prostate Gland and Seminal Vesicles
• The prostate gland:
• Is retroperitoneal (it lies in the portion of the abdominopelvic
cavity posterior to the peritoneal sac), anterior to the rectum
and inferior to the urinary bladder.
• Consists of fibromuscular and glandular tissue that surrounds the
neck of the urinary bladder and prostatic urethra (portion of
male urethra surrounded by prostate gland).
• Is about the size of a chestnut and conical in shape; approximately
3.5 cm long, 4.0 cm wide, and 2.5 cm anterior to posterior. The
base, its broadest aspect, is superior to its apex.
• The glandular portion of the prostate is divided into 3 zones
(Figure 14-1):
1. Peripheral zone: located posterior and lateral to the distal
prostatic urethra. Normally, it is the largest zone.
2. Central zone: extends from the base of the prostate to the
verumontanum (landmark area near the center of the pros-
tate gland) and surrounds the ejaculatory ducts (two ducts
that transport sperm and pass through the prostate gland to
empty into the prostatic urethra).
3. Transition zone: located on both sides of the proximal ure-
thra. Normally, it is the smallest zone.
• The seminal vesicles:
• 2 convoluted, sac-like structures that lie superior to the pros-
tate gland and posterior to the urinary bladder.
• Approximately 5 cm (2 inches) in length and less than 1 cm in
diameter. They join the vas deferens ducts (part of ductal system that transports sperm) to form the ejaculatory ducts.
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 345
e
PU = proximal urethra
DU = distal urethra
VM = verumontanum
VD = vas deferens duct
ED = ejaculatory duct
SV = seminal vesicle
AXIAL VIEW
ANTERIOR
Urethra
RIGHT
SV
SAGITTAL VIEW
PU
BASE
(cephalic)
VD
Periurethral stroma
Fibromuscular stroma
SV
ED
Figure 14-1 Prostate glandular zones.
POSTERIOR
ANTERIOR
POSTERIOR
Central zone
LEFT
ED
SV
VM
DU
APEX
(caudal)
Peripheral zon
Transition zone
Scrotum and Testicles
• The scrotum:
• Is a pouch of skin that is continuous with the abdomen. It is sus-
• Externally, the median raphe or median ridge divides the
• Internally, the scrotum is divided into 2 sacs by a septum that is
• 2 spermatic cords extend from the scrotum through the ingui-
pended from the base of the male pelvis between the perineum
(area between the anus and the scrotum) and the penis.
scrotum into lateral portions.
formed by the continuation of the external skin, superficial fascia,
and contractile tissue. Each scrotal sac contains a testis, epididymis,
and proximal portion of the ductus (vas) deferens (Figure 14-2).
nal canals and internal inguinal rings into the pelvis. Each
cord contains the ductus (vas) deferens, testicular arteries, venous
pampiniform plexus (veins that drain the testes and become the
spermatic veins superiorly) lymphatics, autonomic nerves, and
cremaster muscle fibers.
346 PART IV Pelvic Scanning Protocols
Urogenital diaphragm
Seminiferous tubule
Symphysis pubis
Urethra
Efferent ducts
Penis
Tunica albuginea
Septum
Bladder
Figure 14-2 Scrotal anatomy.
Seminal vesicle
Ejaculatory duct
Prostate gland
Bulbourethral gland
Head of epididymis
Ductus deferens
Body of epididymis
Mediastinum
Tail of epididymis
Scrotum
• Each testicle is:
• A male gonad. Male gonads are the organs that make the gametes
(spermatozoa).
• Approximately 1.5 to 2 inches (3 to 5 cm) long, 1 inch (2 to
3 cm) wide, and 1 inch (2 to 3 cm) anteroposteriorly. Before
age 12, testicular volume is less than 5 mL. With maturity, the
average testicular volume is approximately 25 mL. Testicular size
decreases with advancing age.
• Covered by tunica albuginea, a dense fibrous tissue which extends
into the posterior testicle wall and forms the mediastinum testis
and interlobar septa:
• The septa of the mediastinum radiate into the testicle and
separate into 200 to 300 lobules. Each lobule contains 1 to 3
convoluted seminiferous tubules that produce sperm then
empty it into the straight tubules, which lead to a network
of ducts called the rete testis. This network of ducts exits the
testis through the mediastinum testis into a series of coiled
epididymal efferent ducts.
• The epididymis is primarily composed of the ductus epididy-
mis a single convoluted, tightly wrapped, 1.5 inch, smooth
muscle tube encapsulated by a serosal layer. When unwrapped,
the tube measures about 20 feet (6 m) in length and 1.5 inches
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 347
(3.8 cm) in diameter. The epididymis is connected to the superior portion of the testis and runs along the posterior aspect to
the base of the testis, where it drains into the ductus (vas) deferens. The ductus epididymis is subdivided into a head, body,
and tail: the head (globus major) is the larger superior portion
consisting mostly of the efferent ducts that empty into the
ductus epididymis; the body runs along the posterior aspect of
the testis and contains the ductus epididymis; the tail (globus
minor) is the smaller inferior portion, where the ductus epididymis empties into the ductus (vas) deferens.
• The ductus (vas) deferens is a thicker, less convoluted continuation of the ductus epididymis that joins with the seminal vesicles to form the ejaculatory ducts, which course
through the prostate and empty into the prostatic urethra.
Penis
• The penis:
• Is composed of 3 cylindrical masses of smooth muscle and erec-
tile tissue that enclose vascular cavities:
• 2 corpora cavernosa situated dorso-laterally and
• 1 corpus spongiosum in the midventral region, which con-
tains the spongy urethra (longest portion of male urethra).
• The 3 corpora are bound and separated by fibrous tissue, the
tunica albuginea. Superficial to the tunica albuginea is a thick
fibrous envelope and a loosely applied covering of skin, called
Buck’s fascia (Figure 14-3).
• Along with the urethra, receives blood from the pair of punden-
dal arteries, which are branches of the internal iliac arteries. The
primary veins of the penis are the superficial and deep dorsal
veins.
Physiology
• As part of reproduction, the male genitourinary tract provides a
means to perpetuate the species.
• The male gametes or spermatozoa are produced in the testes and
mature in the epididymis. The function of the ductal system is to
store and help propel the sperm during ejaculation via the penis.
Without the alkaline secretions from the prostate gland and seminal vesicles, the sperm could not survive to complete the process of
reproduction.
• The reproductive function of the penis is to eject semen into the
female vagina. During ejaculation, increased pressure within the
urethra causes the urinary bladder sphincter to close, which prevents urine from being expelled into the vagina and semen from
entering the bladder.
348 PART IV Pelvic Scanning Protocols
Subcutaneous lateral vein
B
Urinary bladder
Seminal vesicle
Ejaculatory duct
Prostate gland
Deep artery of penis
Corpus spongiosum
Corpora cavernosum
Urethra
Glans penis
Prepuce (foreskin)
A
Skin
Superficial fascia
Corpus spongiosum
Urethra
Tunica albuginea
Deep fascia (Buck’s fascia)
Corpus cavernosum
Deep artery of penis
Dorsal artery
Deep dorsal vein
Subcutaneous dorsal vein
Figure 14-3 Penile anatomy. A, Longitudinal section. B, Short axis section.