Segmental testicular infarctions are uncommon testicular lesions that present with pain. They affect only a segment of the testis that is devascularised with normal remaining testicular parenchyma.
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Epidemiology
Segmental testicular infarct is much uncommon compared to global testicular infarction. It is often idiopathic and affects patients in their second to fourth decades.
Presentation
Acute non-specific testicular pain and swelling.
Pathology
Segmental testicular infarct usually results from arterial embolization or thrombosis (as opposed to testicular infarction from torsion, which may originate from venous occlusion).
The testicle has a triple arterial blood supply: the testicular artery, the cremasteric artery, and the artery of ductus deferens. Segmetal infarction occurs of interruption of one of these arteries occurs. It usually affects the upper pole of the testis 3.
The causes of a segmental testicular infarct include:
- orchitis
- sickle cell disease
- trauma
- pelvic surgery (such as herniorrhaphy)
- vasculitis
Radiographic features
Ultrasound
- focal hypoechoic region in the testis
- wedge-shaped or rounded
- absence of color Doppler flow in the hypoechoic region
- slight retraction of the tunica albuginea adjacent to the lesion may be seen
MRI
- appears as a well-defined lesion, mostly located at the upper pole
- T1WI usually appears isointense and can show hyperintense foci of hemorrhage
- T2 WI shows a hypointense area surrounded by a complete hypointense rim
- post-contrast T1WI shows absence of enhancement except for the rim
- no infiltration to tunica or vascular structures
Differential diagnosis
The important differential diagnosis for a focal hypoechoic region in the testis is a testicular neoplasm. A segmental infarct will show decreased color Doppler flow, but this requires scrupulous attention to color Doppler technique. For practical purposes, include both on a differential unless absolutely sure it is not a neoplasm (e.g. it was not present on a study from a couple of days ago).
Also in the differential:
- intratesticular hematoma
- granulomatous disease of the testis: testicular sarcoidosis, testicular tuberculosis