Segmental testicular infarction following epididymo-orchitis

Case contributed by Youssef Sakhy
Diagnosis almost certain

Presentation

Presented to the ER for acute left testicular pain and fever.

Patient Data

Age: 15 years
Gender: Male

Initial ultrasound

ultrasound

Initial testicular ultrasound showed a hyperechoic heterogenous hypovascular aspect of the lower half of the left testicle associated with hypervascularity and enlargement of the epididymis.

Images 2 days later

ultrasound

The patient was started on antibiotics and corticosteroids and was transferred for another ultrasound due to unresolved symptoms.

It showed avascularity of the lower half of the left testicle and appearance of focal hypoechoic areas.

Surgical exploration found a segmental area of necrosis in the left testicle for which the patient underwent partial orchiectomy.

Case Discussion

Segmental and global testicular ischemia is a rare but severe complication of epididymo-orchitis that needs urgent medical attention and proper management 1. The most common theory is that testicular ischemia occurs when blood flow to the testis is impaired due to the acute inflammatory processes; recruitment of inflammatory cells and edema might compress the blood vessels within the epididymis and testis and result in compartment effect within the testis 2

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