A series of 7 testicular epidermoid cysts were imaged by contrast-enhanced sonography to assess internal vascularity and by real-time tissue elastography to grade stiffness by a visual and strain ratio quantification scoring system. No internal vascular enhancement was seen on contrast-enhanced sonography; the 3 largest lesions showed rim enhancement. On the real-time elastographic color display, all lesions were predominantly blue ("hard"), and the lesions analyzed for the strain ratio had a mean value of 43.57. Contrast-enhanced sonography depicts the absence of vascular flow, and real-time elastography shows that the epidermoid cysts are hard. This combination of information will help further characterize these lesions.
Segmental testicular infarction is a rare cause of acute scrotal pain. The appearances on grey-scale sonography are often indistinguishable from that of a testicular tumour, resulting in unnecessary orchiectomy. We report a case of acute bilateral testicular infarction, of unknown etiology, which was conservatively managed to resolution following a confident diagnosis achieved with the aid of contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE) along with conventional grey-scale and Doppler sonography. The evolving appearances on each of the sonographic modalities are described. We discuss the importance of complementing conventional sonography with CEUS and RTE in order to make a confident diagnosis and avoid unnecessary surgical intervention.Riassunto L'infarto testicolare segmentale è una causa rara di dolore scrotale acuto. L'aspetto ecografico, in scala di grigi, è spesso indistinguibile da quello di un tumore testicolare, con conseguenti orchiectomie inutili. Riportiamo un caso di infarto testicolare acuto bilaterale, ad eziologia sconosciuta, gestito in maniera conservativa fino a risoluzione, dopo una diagnosi realizzata con l'ausilio di ecografia con messo di contrasto (CEUS) e elastosonografia tessutale in tempo reale (RTE), ecografia convenzionale in scala di grigi e Doppler. Sono descritti gli aspetti, in ciascuna delle modalità ecografiche, dell'evoluzione delle lesioni. Discutiamo l'importanza della complementarietà dell'ecografia convenzionale con CEUS e RTE per effettuare una diagnosi di certezza ed evitare un inutile intervento chirurgico.
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