Presentation
Infertility. Azoospermia on semen analysis.
Patient Data
Both testicles appear small in size showing diffuse low signal intensity with a striated appearance.
Findings are suggestive of bilateral testicular fibrosis.
Compare the appearance of the normal testes on the right showing the normal size and homogenous high T2 signal with the fibrotic testes on the left which appear rather small in size showing diffuse low signal with striated appearance.
Case Discussion
In this case, testicular fibrosis might be secondary to remote exposure to mumps with subsequent mumps orchitis and testicular fibrosis.
Testicular fibrosis
- it usually occurs in geriatric people
- in young patients, it might occur secondary to any of the following 1
- postinflammatory following the exposure to mumps or Coxsackie B orchitis
- chemical agents (chemotherapy or radiation)
- dysgenetic as in Klinefelter syndrome or testicular nondescent o hormonal deficits as in hypogonadotropic hypogonadism
- ischemia (vascular injury during hernia repair, atherosclerosis, incomplete torsion), in those cases, fibrosis is usually unilateral
- excretory duct obstruction close to testis as in postorchitis/epididmyitis and varicocele
Radiographic features: Small testicular size together with a striated appearance on US/MRI supports the diagnosis of testicular fibrosis.
This case is courtesy of Dr. Amr Abdel Fatah.