Testicular vasculitis

Last revised by Dr Jeremy Jones on 20 Sep 2021

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. 

The mean age of onset is approximately 40 years.

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.

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 arthritisgiant cell arteritis and Henoch-Schönlein purpura 2,3.

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.

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 diagnoses includes 1:

 

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