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Imaging of Inguino scrotal region

for Radiology student

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Imaging of Inguino scrotal region

  2. 2.  The inguinal ligament  The deep inguinal ring … anatomic defect in the transversalis fascia.  The superficial inguinal ring…. defect in the external oblique aponeurosis immediately superior and lateral to the pubic tubercle. ANATOMY
  3. 3.  Inguinal canal --from the deep to the superficial inguinal ring --3.75 cm long --directed downwards and medially from the deep to the superficial inguinal ring
  4. 4.  CONTENTES spermatic cord (M ) Ilioinguinal nerve Genitofemoral nerve Round ligament of ut ( F)
  5. 5.  Conjoint tendon
  6. 6.  The inferior epigastric artery.
  7. 7. HERNIA…
  8. 8.  in areas of natural weakness  vessels penetrate the abdominal wall (femoral and spigelian)  fetal migration of testis, spermatic cord, or round ligament have occurred (indirect inguinal)  broad flat weak tendons called aponeuroses (direct inguinal). Why does hernia occurs ?
  10. 10. Right inguinal anatomy
  11. 11. RTLT Indirect
  12. 12. 1. Bubonocele.... The hernia is limited to the inguinal canal. 2. Funicular.... The processus vaginalis is closed just above the epididymis. The contents of the sac can be felt separately from the testis, which lies below the hernia. 3. Complete ( scrotal).... The testis appears to lie within the lower part of the hernia. Types of indirect inguinal hernia
  13. 13. Long-axis views Left, Image shows the right direct inguinal hernia sac lying posterior to the spermatic cord (SC). Right, Image shows the left indirect inguinal hernia sac lying anterior to the spermatic cord (SC).
  14. 14. Spigelian fascia, the complex aponeurotic tendon that lies between the oblique muscles laterally and the rectus muscles medially. Spigelian Hernias
  15. 15. Femoral hernias arise within the femoral canal, which lies medial to the common femoral vein just superior to the saphenofemoral junction and inferior to the inguinal ligament. Femoral hernias
  16. 16. 31-year-old woman with femoral hernia. Sonogram of right inguinal region parallel to and caudad to inguinal ligament corresponding to transducer position 4. Pre-Valsalva maneuver sonogram shows (hernia not visible) femoral artery (A), femoral vein (V), and superior pubic ramus (curved arrow).
  17. 17. Post-Valsalva maneuver sonogram shows dilated femoral vein (V) lateral to femoral hernia (arrows). Superior pubic ramus (curved arrow) is also seen.
  18. 18. length 3-5 c.m. width 2-4 c.m.
  19. 19. Prompt diagnosis is needed.
  21. 21. Enlarged to inf pole, only during standing No dilatation on supine Reflux only during Valsalva Grade 3
  22. 22. Supine position also that increased in standing
  23. 23. Supine and even prone position Reflux evident on rest
  24. 24.  usually well-defined,  hypoechoic,  solid ± lobulation.  They don't have calcification nor tunica invasion.  Most seminomas demonstrate increased flow on color Doppler examination  heterogeneous echotexture  irregular or ill-defined margins.  Echogenic foci within the substance of the tumors represent areas of hemorrhage, calcification, or fibrosis.  They frequently have cystic components, consistent with regions of necrosis. SEMINOMA Nonseminomatous germ-cell neoplasms
  25. 25. TB,Filariasis,sarcoid
  26. 26. Sperm granuloma
  27. 27. Scrotal mesothelioma
  28. 28. Hydrocele  Abnormal collection of serous fluid in a part of the processus vaginalis, usually the tunica.  Types…
  29. 29.  High-resolution real-time sonography has a high degree of accuracy and sensitivity in the detection, characterization, and localization of scrotal lesions, making it the undisputed modality of choice for imaging the scrotum.  In the pediatric population, sonography is helpful in the diagnosis of developmental abnormalities, epididymitis, testicular torsion, and testicular neoplasms. CONCLUSION
  30. 30. THANK YOU…….