Segmental Infarct of the Testis Due to Hypersensitivity Angiitis

Baer, Harry M.; Gerber, Walter L.; Kendall, A. Richard; Locke, J. Laron; Putong, Paul B.

doi:10.1016/s0022-5347(17)38682-2

Cited by 38 publications

(17 citation statements)

References 5 publications

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“…It has also been reported secondary to surgery for inguinal hernia repair (31,32), vasectomy (33), or varicocelectomy (34). Other less common predisposing factors for segmental infarction include polycythemia (29), intimal fibroplasia of the spermatic artery (35), sickle cell disease (36) or sickle cell trait (37), hypersensitivity angiitis (38), and trauma. A bell clapper deformity leading to repeated torsion-detorsion episodes is also a predisposing factor for segmental testicular infarct (39).…”

Section: Focal/segmental Testicular Infarctmentioning

confidence: 99%

Non neoplastic intratesticular masses

Bhatt¹,

Jafri²,

Wasserman³

et al. 2009

Diagn Interv Radiol

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High-frequency ultrasonography is the first modality of choice for the evaluation of scrotal pathology. The use of high-frequency ultrasound is increasing, allowing detection and better characterization of many benign intrascrotal lesions that can be treated with non-surgical management or testicular-sparing surgery.This pictorial essay presents gray-scale and color-flow Doppler features of non-neoplastic intratesticular masses. For ease of understanding, the review is organized into three major categories: cystic, vascular, and solid non-neoplastic masses. Table summarizes the key sonographic features, each with recommended management. Sonographic anatomy of the testisThe normal adult testes in each hemi scrotum are symmetric in size and measure approximately 5x3x2 cm. On ultrasound, a normal testis is identified by the presence of homogeneous, medium-level echoes and is contained by a fibrous sheath called the tunica albuginea. The tunica albuginea is identified on ultrasound as a thin echogenic line around the testis and is externally covered by the tunica vaginalis. The tunica vaginalis consists of visceral and parietal layers that are normally separated by a few milliliters (2-3 mL) of fluid. The tunica attaches to the scrotal wall at the posterolateral aspect of the testis. From the posterior aspect of the testis, the tunica albuginea invaginates within the testis to form an incomplete septum, called the mediastinum testis. Sonographically, the mediastinum testis appears as an echogenic band of variable thickness that extends across the testis in the longitudinal axis (Fig. 1). Multiple fibrous septa extend from the mediastinum into the testis, dividing it into 250 to 400 lobules. Spermatogenesis occurs within the seminiferous tubules contained within these lobules. The seminiferous tubules open into dilated spaces called the rete testis within the mediastinum via the tubuli recti. The normal rete testis can be seen on high-frequency US in 18% of patients. (1). The rete testis drains into the epididymis via 10 to 15 efferent ductules.There are four testicular appendages (remnants of the mesonephric and paramesonephric ducts): the appendix testis (hydatid of Morgagni), the appendix epididymis, the vas aberrans, and the paradidymis. The appendix testis and the appendix epididymis are commonly seen on scrotal US. The appendix testis is a small ovoid structure usually at the upper pole of the testis in the groove between the testis and the epididymis, better seen by the presence of fluid around the testis.The testes are supplied by testicular arteries that arise from the abdominal aorta. The testicular arteries enter the spermatic cord at the deep inguinal ring and continue along the posterior surface of the testis, penetrating the tunica albuginea and forming the capsular arteries that course through the tunica vasculosa, which underlies the tunica ABDOMINAL IMAGING PICTORIAL ESSAY Imaging of non-neoplastic intratesticular massesShweta Bhatt, Syed Zafar H. Jafri, Neil Wasserman, Vikram S. Dogra ABSTRACTThe u...

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Section: Focal/segmental Testicular Infarctmentioning

confidence: 99%

Non neoplastic intratesticular masses

Bhatt¹,

Jafri²,

Wasserman³

et al. 2009

Diagn Interv Radiol

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“…It generally presents as painful and tender testicle [31], as a mass mimicking malignancy [26,[32][33][34][35][36][37], or as persistent epididymitis [31,38]. It generally presents as painful and tender testicle [31], as a mass mimicking malignancy [26,[32][33][34][35][36][37], or as persistent epididymitis [31,38].…”

Section: Single-organ Vasculitis Involving the Male Genital Tractmentioning

confidence: 99%

Single-organ vasculitis

Hernández‐Rodríguez

Molloy

Hoffman

2008

Current Opinion in Rheumatology

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“…Clinically, segmental testicular infarction presents with acute scrotal pain and is indistinguishable from other causes of scrotal pain. A number of factors for segmental testicular infarction have been proposed: epididymo-orchitis, trauma, sickle cell disease, polycythaemia, hypersensitivity angiitis, intimal-fibroplasia of the testicular artery and previous surgery [5][6][7][8][9]. In the majority the cause is attributed to infection, but is termed 'idiopathic' if a cause is not found [7,10].…”

mentioning

confidence: 99%

Clinical and ultrasound features of segmental testicular infarction: Six-year experience from a single centre

et al. 2007

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The purpose was to analyse the aetiology and ultrasound appearances of segmental testicular infarction. Patients with focal testicular lesions underwent colour Doppler high frequency ultrasound. Segmental testicular infarction was defined as any focal area of altered reflectivity, with or without focal enlargement with absent or diminished colour Doppler flow, proven on histology or on follow-up exclusion of lesion progression. Patients were reviewed to document lesion shape, position, border definition, reflectivity and vascularity and correlated to presenting clinical symptoms and signs. Over a 6-year period 24 patients were defined as having segmental testicular infarction; median age was 37 years (range 16-82 years). All presented with a sudden onset of testicular pain. Of the patients, 14/24 (58.3%) had scrotal inflammatory disease, 5/24 (20.8%) had evidence of spermatic cord torsion, and three patients were termed idiopathic; 12/24 (50.0%) were of low reflectivity, 11/24 (45.8%) of mixed reflectivity, one of high reflectivity, 11/24 (45.8%) were wedge shaped, and 13/24 (54.2%) were round shaped. Of the patients, 8/24 (33.3%) demonstrated a mass effect, all with round-shaped lesions and with underlying epididymo-orchitis in seven. Absent colour Doppler flow was demonstrated in 20/24 (83.3%). Histology confirmed infarction in 8/24 (33.3%), and 12/24 (50.0%) had follow-up examinations without progression of the lesions. Segmental testicular infarction has characteristic ultrasound features, not always wedge-shaped, with reduced or absent vascularity of key importance. Awareness of the ultrasound features will allow for conservative management and avoid unnecessary orchidectomy.

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Segmental Infarct of the Testis Due to Hypersensitivity Angiitis

Cited by 38 publications

References 5 publications

Non neoplastic intratesticular masses

Non neoplastic intratesticular masses

Single-organ vasculitis

Clinical and ultrasound features of segmental testicular infarction: Six-year experience from a single centre

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