Diagnostic ultrasound ( PDFDrive )

CHAPTER 54 Pediatric Pelvic Sonography 1891
he number of testes may vary. Polyorchidism (testicular
duplication) typically manifests in the older child as an asymptomatic
scrotal mass, but occasionally it will manifest with pain
due to torsion. he testes share a common epididymis, vas
deferens, and tunica albuginea. Usually, a single, small, accessory
testis is demonstrated within the scrotum in addition to two
normal testes (triorchidism). 99 A bilobed testis may mimic a
duplicated testis. Polyorchid and bilobed testes have medium-level
homogeneous echogenicity and are smaller than the contralateral
testis.
Testes smaller than normal may result from cryptorchidism,
torsion, inlammation, varicocele, prior inguinal hernia repair,
radiation treatment, and trauma. Congenital causes include
Klinefelter syndrome and primary hypopituitarism. hese
small gonads may have normal, increased, or decreased
echogenicity. 97
True hermaphroditism is an intersex condition in which the
patient has both ovarian and testicular tissue, in the form of
either separate structures or an ovotestis. Ultrasound can
demonstrate the textural diference within an ovotestis in that
the testicular portion is more homogeneous with medium-level
echoes, whereas the ovarian tissue is more heterogeneous with
small, anechoic, cystic follicles interspersed with the low- to
medium-level parenchymal echogenicity 100 (Fig. 54.31). hese
patients are seen either prepubertally with ambiguous genitalia
or postpubertally with the development of gynecomastia, cyclic
hematuria, or cryptorchidism in a patient reared as a boy, or
amenorrhea in a patient reared as a girl (Fig. 54.32).
Cystic dysplasia of the testis is a rare congenital condition
consisting of dilated rete testis and eferent ducts, as well as
adjacent parenchymal atrophy. Patients typically have painless
scrotal enlargement at a mean age of 5.8 years. 101 he ultrasound
appearance consists of multiple, small, anechoic, cysts predominantly
in the region of the mediastinum testis (Fig. 54.33). he
1
2
FIG. 54.31 Ovotestis. Ovotestis in a 15-year-old phenotypic boy
with gynecomastia, intermittent scrotal pain and swelling, and recent
scrotal trauma. Sagittal sonography of the right hemiscrotum revealed
a heterogeneous right gonad (calipers) with focal cystic areas representing
follicles in the upper pole (arrows). This gonad contained ovarian and
testicular tissue.
A
B
RT
C
LT
Bladder
Bladder
D
CATH 1 CM AIR
BLADDER TRV
E
CATH 1 CM H2O
BLADDER TRV
FIG. 54.32 Testicular Feminization Syndrome. This 5-year-old girl underwent bilateral inguinal herniorrhaphies. At surgery, the tissue within
each of the inguinal canals felt irmer than expected in the presence of normal herniated ovaries, and thus both were biopsied. (A) Sagittal scan
of the normal-appearing urinary bladder reveals no evidence of a uterus or ovaries. (B) and (C) Male-type gonads are seen bilaterally, as evidenced
by the homogeneity and lack of follicles in either gonad. Biopsy of both gonads revealed normal, male-type gonads. (D) and (E) Using the bladder
as a sonic window, the length of the vaginal canal was assessed by injecting air and then sterile water into the vaginal opening during sonographic
observation. The vaginal canal was extremely short, approximately 1 cm in length.