Segmental Testicular Infarction

Abstract

egmental testicular infarction is a localized infarct of the testis. Case reports have described it in relation to epididymoorchitis, trauma, sickle cell disease, polycythemia, hypersensitivity angitis, intimal fibroplasia of the testicular artery, and as a complication of recent surgery. [1][2][3][4][5] Most cases, however, have no clear etiology and are considered idiopathic. 6 Scrotal pain is the predominant presenting symptom. Consequently, sonography with color Doppler is the initial imaging modality of choice. Wedge-shaped or round hypoechoic intratesticular lesions with absent or low flow on color Doppler sonography have been most often described in the literature. 6-9 Perilesional hyperemia has also been described. Contrast-enhanced magnetic resonance imaging and sonography can increase confidence in the diagnosis of segmental testicular infarction by showing perilesional rim enhancement. 10 In many cases, however, a definitive diagnosis is made histologically only after orchiectomy.A few case series and case reports have been published, but there is a paucity of radiologic-pathologic correlation in the literature. To our knowledge, this is the most extensive clinical-pathologic and radiologic-pathologic series to date. The purpose of this series is to describe the sonographic features of pathologically proven cases of segmental testicular infarction and present the associated histologic findings. CASE SERIESSegmental testicular infarction can mimic testicular carcinoma on sonography and can lead to unnecessary orchiectomy. This case series describes and correlates sonographic and histologic findings of 7 pathologically proven segmental testicular infarction cases. Segmental testicular infarction should be suspected on sonography when a geographic lesion with low or mixed echogenicity has absent or near-absent flow in a patient with scrotal pain. A hyperechoic rim and peripheral hyperemia correspond to interstitial hemorrhage and inflammatory changes. As an infarct evolves, it becomes more discrete and hypoechoic as ghost outlines replace seminiferous tubules. Follow-up or contrastenhanced magnetic resonance imaging or sonography can increase diagnostic confidence in suspected cases and prevent unnecessary orchiectomy.

Segmental testicular infarction: a case report

“…T2-weighted images typically show a hypodense area with absence of enhancement except for the rim. On contrast-weighted T1-weighted images a segmental testicular infarction may appear isointense or show hemorrhagic foci of high signal intensity [12]. A MRI was performed in our case showing a heterogenic hypointensity (16×22×12 mm) in the upper part of our patient’s left testicle, which appeared ischemic after contrast enhancement.…”

Testicular tumour, could it be benign? A clinical conundrum

“…Ultrasound is the imaging of choice in an unknown testicular lesion 1 and it's important to note that progressive ultrasound findings of heterogenous lesion being hypoechoic and unchanging in size 5 is seen in both malignant and vasculitic processes which reflects the difficulty in distinguishing testicular inflammation from neoplastic disease 1 …”

Segmental Testicular Infarction, an Underdiagnosed Entity: Case Report with Histopathologic Correlation and Review of the Diagnostic Features

“…Despite the available imaging modalities, the diagnosis of segmental testicular infarction remains challenging. The radiologic-pathologic correlation in most case series remains suboptimal and definitive diagnosis in many patients is obtained after orchiectomy [ 4 , 11 ]. When the diagnosis is made based on clinical data, most patients improve with conservative management [ 7 , 11 , 12 ].…”

“…In the absence of tumor markers or low clinical suspicion of malignancy, postponing surgery with longer-term follow-up should be considered to avoid unnecessary orchiectomy. Surgery may still be needed for patients who show progression of the disease or other concerning findings [ 4 , 5 , 11 ].…”