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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 arthritis, giant 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 color 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 orchiectomy 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 localized infarction on orchiectomy 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:
- 1. Stroup SP, Herrera SR, Crain DS. Bilateral testicular infarction and orchiectomy as a complication of polyarteritis nodosa. (2007) Reviews in urology. 9 (4): 235-8. Pubmed
- 2. Barber TD, Al-Omar O, Poulik J, McLorie GA. Testicular infarction in a 12-year-old boy with Wegener's granulomatosis. (2006) Urology. 67 (4): 846.e9-10. doi:10.1016/j.urology.2005.10.036 - Pubmed
- 3. Brimo F, Lachapelle J, Epstein JI. Testicular vasculitis: a series of 19 cases. (2011) Urology. 77 (5): 1043-8. doi:10.1016/j.urology.2011.01.021 - Pubmed
- 4. Fernández-Pérez GC, Tardáguila FM, Velasco M, Rivas C, Dos Santos J, Cambronero J, Trinidad C, San Miguel P. Radiologic findings of segmental testicular infarction. (2005) AJR. American journal of roentgenology. 184 (5): 1587-93. doi:10.2214/ajr.184.5.01841587 - Pubmed
- 5. Dixit A, Hague C, Bicknell S. Testicular Vasculitis: A Sonographic and Pathologic Diagnosis. (2017) Case reports in radiology. 2017: 8923621. doi:10.1155/2017/8923621 - Pubmed
- 6. Madaan S, Joniau S, Klockaerts K, DeWever L, Lerut E, Oyen R, Van Poppel H. Segmental testicular infarction: conservative management is feasible and safe. (2008) European urology. 53 (2): 441-5. doi:10.1016/j.eururo.2007.03.061 - Pubmed
- 7. Souza AW, Rosa DP, Buosi AL, Oliveira AC, Natour J. Testicular vasculitis: a rare manifestation of rheumatoid arthritis. (2013) Revista brasileira de reumatologia. 53 (4): 365-7. Pubmed
- 8. Nigro KG, Abdul-Karim FW, MacLennan GT. Testicular vasculitis. (2006) The Journal of urology. 176 (6 Pt 1): 2682. doi:10.1016/j.juro.2006.09.005 - Pubmed
- 9. Hernández-Rodríguez J, Tan CD, Koening CL, Khasnis A, Rodríguez ER, Hoffman GS. Testicular vasculitis: findings differentiating isolated disease from systemic disease in 72 patients. (2012) Medicine. 91 (2): 75-85. doi:10.1097/MD.0b013e31824156a7 - Pubmed