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Age: 45

Sex: Male

Indication: Bilateral testicular pain

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Case #48


Findings

  • Heterogeneous bilateral testicular echotexture with increased bilateral testicular and epididymal vascularity
  • Rounded hypoechoic structure in the right testis measuring 2.8 x 2.7 x 2.1 cm without internal vascularity
  • Moderate right and small left hydroceles with minimal internal echogenic debris but no loculations
  • Edematous appearance of the scrotum


Diagnosis

Segmental testicular infarct

Sample Report

Heterogeneous bilateral testicular echotexture with increased bilateral testicular and epididymal vascularity, concerning for bilateral epididymo-orchitis.

Rounded hypoechoic structure in the right testis measuring 2.8 x 2.7 x 2.1 cm without internal vascularity, which may represent a developing abscess, hypovascular or centrally necrotic testicular neoplasm, granulomatous disease, or segmental testicular infarct. Recommend urology consultation and followup imaging with ultrasound or MRI following treatment for further assessment.

Moderate right and small left hydroceles with minimal internal echogenic debris but no loculations, likely reactive.

Edematous appearance of the scrotum.


Discussion

  • Segmental testicular infarcts are rare but important to include on the differential diagnosis for hypovascular testicular lesions
  • Risk factors for segmental testicular infarcts include testicular infections, trauma, and hematologic disorders including sickle cell disease
  • The diagnosis can be difficult to confidently make on imaging and patients may require orchiectomy to confidently exclude neoplasm (which was required in this case)
  • Findings that favor a segmental infarct over neoplasm include:
    • Triangular morphology (though segmental infarcts may be rounded, as in this case)
    • Abrupt onset (if you have the luxury of recent comparison imaging where it was not present)
    • A clearly defined enhancing rim on MRI


Images

Hypoechoic mass in the right testicle without definite internal vascularity (red arrows), which was proven on pathology to represent a segmental testicular infarct.

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