Testicular adrenal rests

Case contributed by Fabien Ho


Known congenital adrenal hyperplasia, supplemented. Painless palpable testicular nodules.

Patient Data

Age: 20 years
Gender: Male

Bilateral coarse echogenic round nodules with clear borders and mostly peripheral vessels.


Testes have a nodular architecture, with signal isoT1 to muscle and hypoT2.

Expected testes signal is rather hyperT2, with clear round non-nodular borders.

Case Discussion

Adrenal inclusions within testes are great mimics of testicular tumors.

However, helpful clues that may help to be confident in adrenal rests are:

  • known history of congenital adrenal hyperplasia
  • bilateral and confluent nodules
  • next to testicular hilum
  • round borders, attenuating echoes
  • no calcifications, non-hypervascular on color Doppler

It is worth noting that MRI, in this case, has no proven diagnostic value. US remains the gold standard.

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