Testicular hypoperfusion

Case contributed by Dr Jason Robert Young

Presentation

Acute left scrotal pain

Patient Data

Age: 60 years
Gender: Male
Ultrasound

Absent color and spectral Doppler signals in the left testis.  Enlarged and heterogeneous left testis.

Testicular scintigraphy using 440 MBq (12 mCi) Tc99m free pertechnetate

Nuclear medicine
  • 2 min flow study:  bilateral iliac artery patency and subtle radiotracer accumulation overlying the left scrotum
  • central photopenic of the left testis with surrounding hyperemic rim

Case Discussion

Patient initially presented to the emergency room with acute left scrotal pain.  An ultrasound was interpreted as left testicular torsion. Urology was consulted and recommended a nuclear medicine testicular scan, given low likelihood of torsion in a 60 year old.  The nuclear medicine testicular scan was interpreted as ischemic change to the left testis, possible etiologies including testicular torsion, embolic atherosclerotic disease, entrapped left inguinal hernia or abdominopelvic mass impairing gonadal artery blood flow.

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