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Age: 68

Sex: Male

Indication: Left testicular pain

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Case #38


Findings

  • Normal, symmetric testicular size, echogenicity, and vascularity bilaterally
  • Multiple dilated tubular and cystic structures in the mediastinum testis bilaterally
  • Bilateral testicular microlithiasis
  • Bilateral epididymal cysts
  • No hydrocele or varicocele


Diagnosis

  • No acute findings
  • Tubular ectasia of the rete testis
  • Testicular microlithiasis

Sample Report

No findings to explain acute testicular pain. No evidence for testicular torsion.

Bilateral tubular ectasia of the rete testis, which is an incidental finding requiring no followup imaging.

Bilateral testicular microlithiasis, which is a commonly incidental finding in adults. If the patient is at average risk for testicular cancer, then no further imaging followup is recommended. If he is at increased risk (e.g. personal history or first-degree relative with history of testicular cancer, history of cryptorchidism or testicular maldescent, or testicular atrophy), then urology referral is recommended for further assessment.


Discussion

  • Tubular ectasia of the rete testis is a benign condition that may mimic pathology
  • It is more common in older men and results from impaired drainage of epididymal tubules, which may be idiopathic or related to prior surgery (e.g. vasectomy), infection, trauma, or neoplasm
  • It is bilateral in about one-third of cases
  • On ultrasound, look for dilated cystic spaces in the mediastinum testis (an incomplete echogenic vertical septation within the testis resulting from infolding of the tunica albuginea)
  • Differential considerations include:
    • Cystic dysplasia of the testicle – a congenital condition associated with ipsilateral urogenital tract abnormalities
    • Intratesticular varicocele – should have flow on Doppler analysis unlike tubular ectasia

 

  • Testicular microlithiasis has been a moving target over the years, with more recent research in adults suggesting a weak, if any, association with testicular cancer
  • Current recommendations in adults suggest no imaging followup in patients at average risk for testicular cancer and urology referral to determine best management in patients at increased risk (including personal history of testicular cancer, first degree relative with testicular cancer, history of cryptorchidism or maldescent, or testicular atrophy)
  • In contrast, recent research suggests a strong correlation between testicular microlithiasis and testicular cancer in children


Images

Multiple cystic structures along the mediastinum testis (red arrows), consistent with tubular ectasia of the rete testis.

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