Testicular vasculitis can occur as either part of a systemic vasculitis or an isolated vasculitis involving only the testes with both having roughly equal prevalence. 

Epidemiology

The mean age of onset is approximately 40 years.

Clinical presentation

Symptoms can include a testicular mass with or without pain, pain alone, an epididymal mass or can be asymptomatic altogether ¹. The absence of physical symptoms (constitutional and musculoskeletal) and normal laboratory findings (such as ESR and FBC) are more commonly found in isolated testicular vasculitis compared to systemic testicular vasculitis ¹.

Pathology

Aetiology

Systematic diseases reported to cause testicular vasculitis are most commonly polyarteritis nodosa (~65%) and granulomatosis with polyangiitis (~20%) ¹. However, it has also been noted to occur with rheumatoid arthritis, giant cell arteritis and Henoch-Schönlein purpura ^2,3.

Radiographic features

Ultrasound

Ultrasonography is the main investigation for vasculitis of the testis and may show areas of reduced or absent testicular artery flow and a testis with a heterogeneous appearance with multiple hypoechoic mass-like areas ^4,5.

Cases of infarction may reveal a solid hypoechoic mass-like area in the testes and the absence of colour Doppler flow in the affected and surrounding region ⁶.

Treatment and prognosis

In patients with no history of systematic vasculitis, these diseases should be excluded. Treatment for testicular vasculitis usually includes orchidectomy ¹. However, in some cases where systemic treatment for an underlying vasculitis is commenced partial reperfusion of the testis can occur ⁸.

Testicular infarction is a possible complication of testicular vasculitis. In one case series, 100% of patients with vasculitis had evidence of localised infarction on orchidectomy ⁷. However, in addition to segmental infarction, a variety of patterns has been reported including unilateral complete infarction and even bilateral complete infarction ^4,9.

Differential diagnosis

Differential diagnoses includes ¹:

• orchitis
• testicular tumour
• testicular torsion