Presentation
History of vague right testicular pain of about 1 week of evolution. No other symptoms were referred. Patient denied trauma, comorbidities or other relevant data. A testicular ultrasound was performed at the ER, followed by a MRI.
Patient Data
Ultrasound images show an ill-defined hypoechogenic, heterogeneous lesion, with a wedge shape that had its apex at the testicular mediastinum and a peripheral base. There was a complete absence of flow at color Doppler on the inside, while it was preserved of the rest of the testicular parenchyma.
MRI images show a well-defined pyramid-like lesion of similar morphologic characteristics to the ultrasound findings. It had internal T1 and T2 hyperintensity and a hypointense rim on both sequences, suggesting the presence of blood products. After the administration of Gadolinium the lesion showed no enhancement, with normal appearance of the rest of the testicular parenchyma.
Case Discussion
The finding of testicular pain associated with an avascular lesion should always take into consideration the possibility of an ischemic lesion. In this case, it was suggested by ultrasound and confirmed by MRI, showing findings compatible with a segmentary right testicular infarction. The patient had symptomatic treatment with analgesics and is currently undergoing tests to rule out coagulopathies.
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