Testicular microlithiasis, also known as intratubular tes,. ticular calcification, is a rarely encountered problem in urology. Now, with the easy availability of high-frequency real-time ultrasound scans, along with their exquisite resolution, sonographic evaluation of the scrotal contents has become an invaluable source of significant clinical information to urologists. We recently examined a patient with testicular microlithiasis; and we present here what we believe is the first report of the unique sonographic appearance of this condition.
REPORT OF A CASEA 23-year-old man was evaluated because of a small right testis. The only pertinent finding in his urolOgic history was a right orchiopexy performed at age 10 for cryptorchidism. On physical examination, he had a well-healed right inguinal incision; a small, mobile, and high-riding right testis; and a normal left testis. The consistency and shape of both testes were normal to palpation, as were the remainder of the scrotal contents. A high-frequency real-time scrotal ultrasound examination was performed, which was markedly abnormal. Using a Diasonics scanner, equipped with a lO-MHz transducer, a unique appearance was encountered. Both testes were somewhat small-the right measuring 2.5 em in length, and the left Received September 17, 1985, from the Departments of ·Radiology -Ultrasound, tUrology, and tpathology, Both testes had an identical appearance that was unusual, and, indeed, unique in the experience of our laboratory. Each testis had a pattern of innumerable tiny bright echoes diffusely and uniformly scattered throughout their substance (Fig. 1). This picture was coupled with the finding of significant attenuation of the ultrasound beam. With the normal testis (Fig. 2) usually being such an excellent transmitter of ultrasound, the situation in this patient was exactly the oppo~ site, with poor penetration of the ultrasound beam through the testis, and great difficulty in imaging the architecture of the testis. The scrotal skin was not thickened, nor excessively hairy, and reapplication of scanning gel did not improve the appearance. Scanning of the adjacent thigh produced normal images; and it became obvious that it was the testicular substance itself, and not the equipment, that was interfering with our ability to evaluate the testis. The abnormal testicular pat .. tern encountered in this patient was remarkable for its bilateral, diffuse, symmetrical homogeneity, except for a small (4 mm) focal hypoechoic area in the right testis in a relatively peripheral area, which was persistently seen just before the image was attenuated.Serum tumor markers (alpha fetoprotein and beta HCG) were normal, as were serum testosterone levels. A semen analysis was not done.Since most intra testicular masses are malignant neoplasms, the hypoechoic mass in the right testis, which was seen with ultrasound, was a worrisome finding, and occult tumor had to be ruled ou1. 2 Because of this finding in this patient, who had an increased risk for testicular cancer, since he had ...