Tuesday, September 18, 2012

Segmental Testicular Infarction

The presentation of an acute scrotum in the emergency setting typically leads to a work up for testicular torsion with ultrasound imaging. Accurate diagnosis of acute testicular torsion is important because the risk of global testicular infarction increases with time from onset of symptoms. 

Segmental testicular infarction is a rarer entity that is not well described in the literature. Ultrasound will demonstrate wedge shaped, hypoechoic regions in the testes with absence of vascular flow. The differential diagnosis for this finding is:

  • polycythemia vera
  • intimal hyperplasia of the spermatic artery
  • sickle cell anemia
  • vasculitis
    • systemic lupus erythematosus
    • polyarteritis nodosa
  • venous thromboses (in hypercoagulable states)
  • severe epididymo-orchitis that is unresponsive to treatment
  • trauma

Differentiation between these entities and testicular torsion is important because treatment of the underlying condition (i.e. with steroids for polyarteritis nodosa) can prevent an unnecessary orchidectomy.

Fernandez-Perez GC, Tardaguila FM, Velasco M, et al. Radiologic findings of segmental testicular infarction. AJR Am J Roentgenol 2005;1587-93.
Sriprasad S, Kooiman GG, Muir GH, et al. Acute segmental testicular infarction: differentiation from tumor using high frequency colour Doppler ultrasound. BJR 2001;74:965-7.

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