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

Abstract

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.

A review of ultrasound imaging in scrotal emergencies

“…An uncommon complication is testicular infarction which may be segmental [3,23] or rarely global [24], with absence of colour Doppler signal as the hallmark. Contrast-enhanced ultrasound may be useful in identifying nonviable testicular parenchyma or abscess formation [25].…”

Metachronous bilateral segmental testicular infarction: multi-parametric ultrasound imaging with grey-scale ultrasound, Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE)

“…Segmental testicular infarct is a rare entity that usually presents with an insidious onset of scrotal pain and tenderness with no other findings on clinical or hematological investigations [1,7,8]. The etiology is usually idiopathic; however, cases have been associated with hypercoagulability, vasculitis, torsion, trauma, infection and iatrogenic vessel damage [1].…”

“…The etiology is usually idiopathic; however, cases have been associated with hypercoagulability, vasculitis, torsion, trauma, infection and iatrogenic vessel damage [1]. The first line imaging investigation is usually grey-scale sonography with colour Doppler; however, CEUS [7,8] and RTE [9] are being used to improve characterization of these lesions.…”

“…Variations have been reported in shape (rounded to wedge shaped), echogenicity (hypo-, iso-or hyper-echoic or of mixed echogenicity), vascularity (avascular although hypovascular lesions are seen) and degree of perilesional hypervascularity [1,8]. In addition, the appearances of individual lesions vary as the lesion evolves.…”

“…The sonographic appearances are variable, both wedge-shaped and rounded lesions have been described, and may mimic a primary germ cell tumour of the testis [1]. Distinguishing a segmental infarction from a tumour is of critical importance in order to avoid unnecessary orchiectomy [2].…”