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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 389
17. Same image as number 16 without calipers.
Labeled: LT CORD TRV VAL
18. Axial image of the EPIDIDYMAL HEAD.
Head of epididymis
Labeled: LT EPI HEAD TRV
390 PART IV Pelvic Scanning Protocols
19. Axial image of the SUPERIOR PORTION of the left testis.
Labeled: LT TESTIS TRV SUP
20. Axial image of the MID PORTION of the left testis with medial
to lateral measurement.
Testis superior portion
Testis mid portion
Labeled: LT TESTIS TRV MID
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 391
21. Same image as number 20 without calipers.
Labeled: LT TESTIS TRV MID
22. Axial image of the INFERIOR PORTION of the left testis.
Labeled: LT TESTIS TRV INF
23. Axial image of the EPIDIDYMAL TAIL (if visualized).
Labeled: LT TESTIS TRV INF / EPI TAIL
Testis inferior portion
Tail of epididymis
392 PART IV Pelvic Scanning Protocols
24. Axial image of the MID PORTION BOTH TESTES.
RT LT
Penis Survey
Penis • Longitudinal Survey
Sagittal Plane • Anterior Approach
1. Begin scanning with the transducer perpendicular at the midline
of the most superior portion of the penis. Very slowly slide the
transducer inferiorly, scanning along the length of the penis until
you are beyond it. Notice how the corpora cavernosum stops at
the area of the glans penis. Anteriorly, the homogeneous long section represents the corpus spongiosum. Note the highly echogenic
appearance of the anterior and posterior margins formed by the
tunica albuginea and Buck’s fascia.
2. Return to the superior, midline position then move the transducer
toward the patient’s left side to include the left margin of the
penis. Very slowly slide the transducer inferiorly, scanning along
the length of the penis until you are beyond it. Notice the centrally
located, bright, thin, parallel lines, representing a longitudinal section of the cavernosal arterial walls.
3. Return to the superior, midline position then move the transducer
toward the patient’s right to include the right margin of the penis.
Very slowly slide the transducer inferiorly, scanning along the
length of the penis until you are beyond it. Notice the centrally
located, bright, thin, parallel lines, representing a longitudinal section of the cavernosal arterial walls.
RT testis
Labeled: BILAT TESTES TRV
LT testis
Penis • Axial Survey
Transverse Plane • Anterior Approach
1. Remain in the sagittal scanning plane and return to the superior,
midline position of the penis. Rotate the transducer 90 degrees
into the transverse scanning plane. The short axis view of the penis
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 393
Corpus
a
nosum
spongiosum
Urethra
will include the anteroposterior and right and left lateral margins.
Note the smaller corpus spongiosum just anterior to the pair of corpora cavernosa. Notice how the centrally located, bright walls, and
anechoic, short axis lumen of the cavernosal arteries disrupts the
otherwise homogeneous echo texture of each corpus cavernosum.
2. Keep the transducer perpendicular and very slowly slide the transducer inferiorly, scanning through and beyond the penis. Notice
how the corpora cavernosum stops at the area of the glans penis.
Penis Required Images
NOTE: The required images are a small representation of what a sonog-
rapher visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
spongiosum
Tunica
albugine
Corpus
cavernosum
Deep artery
A
Buck’s
fascia
Tunica
albuginea
Corpus
Deep artery
Corpus
caver
B
Representative longitudinal (A) and short axis (B) image sections of the penis.
394 PART IV Pelvic Scanning Protocols
Penis • Longitudinal Images
Sagittal Plane • Anterior Approach
1. Longitudinal image of the left lateral, superior portion of the
penis to include the corpus spongiosum, corpus cavernosum,
and cavernosal artery.
Labeled: SAG PENIS LT SUP
2. Longitudinal image of the left lateral, mid portion of the penis to
include the corpus spongiosum, corpus cavernosum, and cavernosal
artery.
Labeled: SAG PENIS LT MID
3. Longitudinal image of the left lateral, inferior portion of the penis
to include the corpus spongiosum, corpus cavernosum, and cavernosal artery.
Labeled: SAG PENIS LT INF
4. Longitudinal image of the left lateral glans penis.
Labeled: SAG PENIS LT GLANS
5. Longitudinal image of the right lateral, superior portion of the
penis to include the corpus spongiosum, corpus cavernosum,
and cavernosal artery.
Labeled: SAG PENIS RT SUP
6. Longitudinal image of the right lateral, mid portion of the penis
to include the corpus spongiosum, corpus cavernosum, and cavernosal artery.
Labeled: SAG PENIS RT MID
7. Longitudinal image of the right lateral, inferior portion of the
penis to include the corpus spongiosum, corpus cavernosum,
and cavernosal artery.
Labeled: SAG PENIS RT INF
8. Longitudinal image of the right lateral glans penis.
Labeled: SAG PENIS RT GLANS
Penis • Axial Images
Transverse Plane • Anterior Approach
9. Axial image of the superior portion of the penis to include the
corpus spongiosum, corpus cavernosum, and cavernosal arteries.
Labeled: TRV PENIS SUP
10. Axial image of the mid portion of the penis to include the corpus
spongiosum, corpus cavernosum, and cavernosal arteries.
Labeled: TRV PENIS MID
11. Axial image of the inferior portion of the penis to include the
corpus spongiosum, corpus cavernosum, and cavernosal arteries.
Labeled: TRV PENIS INF
12. Axial image of the glans penis.
Labeled: TRV PENIS GLANS
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 395
Review Questions
Answers on page 630.
1. The male genitourinary system includes the
a) prostate gland, seminal vesicles, scrotum, testicles, and penis.
b) urinary bladder, prostate gland, scrotum.
c) kidneys, a portion of the ureters, musculature, urinary bladder.
d) kidneys, a portion of the ureters, urinary bladder, prostate gland.
2. The prostate gland is located
a) intraperitoneal, anterior to the rectum; inferior to urinary
bladder.
b) retroperitoneal, posterior to the rectum; inferior to urinary
bladder.
c) retroperitoneal, anterior to the rectum; inferior to urinary
bladder.
d) intraperitoneal, around the base of the urethra.
3. The peripheral zone is
a) located on both sides of the proximal urethra.
b) the smallest zone.
c) located posterolateral to the distal prostatic urethra.
d) the extension of the base of the prostate gland to the
verumontanum.
4. The two convoluted sac-like structures that lie superior to the
prostate and posterior to the urinary bladder are the
a) testes.
b) vas deferens ducts.
c) verumontanum.
d) seminal vesicles.
5. Each scrotal sac contains a
a) testis, epididymis, portion of vas deferens duct.
b) testis, seminal vesicle, portion of vas deferens duct.
c) testis, epididymis, seminal vesicles.
d) testis, epididymis, portion of ejaculatory duct.
6. ____________and____________ join to form the ejaculatory ducts.
a) Seminal vesicles, vas deferens ducts.
b) Epididymis, seminal vesicles.
c) Epididymis, vas deferens ducts.
d) Vas deferens ducts, proximal prostatic urethra.
7. Which zone(s) of the prostate gland is normally sonographically
distinguishable?
a) All zones
b) Peripheral zone only
c) Central and peripheral zones
d) Transition zone only
396 PART IV Pelvic Scanning Protocols
8. The ovoid structures with low-level echoes, just superior to the
prostate gland are the
a) vas deferens ducts.
b) seminal vesicles.
c) ejaculatory ducts.
d) epididymis.
9. Compared to the testicle, the echo texture of the epididymis is
a) hypoechoic.
b) slightly hyperechoic and smoother.
c) slightly hyperechoic and more coarse.
d) extremely hyperechoic.
10. The bright line seen running along the long axis of the testis is the
a) epididymis.
b) verumontanum.
c) mediastinum testis.
d) efferent duct.
11. In short axis sections, the corpus spongiosum is identified
a) posterior to the copora cavernosa.
b) at the midline surrounding the urethra.
c) by the centrally located cavernosal artery.
c) posterolateral to the urethra.
12. The prostate gland is about the size of a
a) chestnut.
b) pea.
c) plum.
d) the collapsed urinary bladder.
13. The bright covering of the testes is the
a) spermatic cord.
b) inguinal rings.
c) cremaster muscle.
d) tunica albuginea.
14. What ducts enter the base of the prostate gland and pass through
to the urethra?
a) Ejaculatory
b) Vas deferens
c) Epididymal
d) Inguinal
15. The normal corpus spongiosum and corpora cavernosa will appear
__________ with ____________ echoes.
a) homogeneous, low-level echoes
b) heterogeneous, bright
c) homogeneous, inguinal ring
d) homogeneous, medium-level echoes
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 397
16. The corpora cavernosa are surrounded by the tunica albuginea,
which appears ________.
a) hypoechoic in comparison
b) homogeneous
c) bright
c) heterogeneous
17. The epididymis appears ________ or slightly _________ compared to
the testicle.
a) darker, hypoechoic
b) isosonic, hypoechoic.
c) isosonic, hyperechoic
d) bright, hyperechoic
18. The periurethral glandular stroma that surrounds the urethra is
_________ compared to surrounding prostatic parenchyma.
a) slightly hyperechoic
b) slightly hypoechoic.
c) bright
d) hyperechoic
19. In short axis sections of the corpus cavernosum, _________ are
easily identified in the center.
a) axial sections of the capsular artery
b) axial sections of the corpus spongiosum
c) axial sections of the cavernosal artery
d) long sections of the urethra
20. Superficial to the tunica albuginea is a thick fibrous envelope and a
loosely applied covering of skin, called
a) Buck’s fascia.
b) median raphe.
c) interlobar septa.
d) perineum.
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