Color Doppler ultrasound for the diagnosis of segmental testicular infarction

Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and Other Forms of Testicular Infarction

Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.

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

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.

[Segmental testicular infarction]

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic.

Radiologic Findings of Segmental Testicular Infarction

OBJECTIVE

Our objective was to describe the radiologic findings of segmental testicular infarction and to establish a proper diagnosis that can avoid orchiectomy.

CONCLUSION

The presence of a triangular-shaped avascular intratesticular lesion on sonography or MRI and enhancement of the surrounding borders on enhanced MR images may suggest a presurgical diagnosis of segmental testicular infarction and therefore avoid a total orchiectomy in these patients.

Segmental testicular infarction

Segmental testicular infarction is described in 11-years-old-child presented with acute left hemiscrotal pain and swelling. Clinical examination suggested left testicular tenderness with no evidence of intratesticular mass and the rest of the scrotal contents were normal. Color doppler study suggested a well circumscribed avascular lesion in the upper pole of left testis and provided a clue to diagnosis. Partial orchidectomy resulted in a satisfactory recovery and provided histopathological confirmation of diagnosis. Authors review their experience with this rare entity and the pertinent literature.

Acute segmental testicular infarction: differentiation from tumour using high frequency colour Doppler ultrasound

Segmental testicular infarction is rare, of variable aetiology but usually idiopathic. B-mode ultrasound may demonstrate a focal mass indistinguishable from a testicular tumour, with confirmation only achieved following surgery. We report a case of segmental testicular infarction presenting as a heterogeneous mass on B-mode ultrasound, confidently diagnosed as an area of infarction on high frequency colour Doppler ultrasound and proven on histology. The pre-operative differentiation of tumour from segmental infarction allows testis-sparing surgery.

Segmental hemorrhagic infarction of testis associated with epididymitis

Testicular infarction is most commonly associated with acute testicular torsion. We present the sonographic findings in a case of segmental testicular infarction associated with epididymitis. The gray-scale abnormalities included a round, well-defined, hypoechoic intratesticular mass and heterogeneity and enlargement of the epididymis. Color Doppler sonography demonstrated only minimal blood flow in the intratesticular mass and increased flow in the epididymis. Recognition of acute testicular segmental infarction as a complication of epididymitis may prevent unnecessary orchiectomy.