Intratesticular arteriovenous malformation
A 20 year old male presented with a soft nodule in right testes, probably since last ten years or more, as he recollects.
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A well defined nodular lesion is seen in right testes, with eccentric hyperechoic area with multiple tortuous vascular channels within. Predominantly arterial flow is seen in vessels with color-aliasing and spectral broadening. Few vascular channels are compressible.
Patient was assessed for testicular carcinoma markers, which was negative. Semen analysis was within normal limits. In view of sonographic features, patient was advised for follow-up. Patient is not willing for any surgical intervention at present. Provisional diagnosis of intratesticular AV malformation was considered, in view of predominantly vascular intratesticular lesion, with doppler features of AV malformation. While arterial feeders demonstrate low resistance arterial flow, draining channels are compressible, though pure venous waveform could not be appreciated.
Essential differential diagnosis to be considered is intratesticular varicocele, which will have venous waveform.