Radiologic Findings of Segmental Testicular Infarction
Gabriel C. Fernández-Pérez1,
Francisco M. Tardáguila1,
María Velasco1,
Celso Rivas1,
John Dos Santos2,
Javier Cambronero2,
Carmen Trinidad1 and
Pilar San Miguel3
1 Radiology Department, Povisa Medical Center, Salamanca, St. 5 36211, Vigo
(Pontevedra) Spain.
2 Urology Department, Povisa Medical Center, Salamanca, Vigo, Spain.
3 Pathology Department, Povisa Medical Center, Salamanca, Vigo, Spain.
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Fig. 1A. —MRI of 42-year-old man with acute scrotal pain in left
testicle. Coronal enhanced T1-weighted turbo spin-echo image (TR/TE, 575/11;
4-mm section thickness) shows segmental testicular infarction in upper
hemisphere of testicle. Lesion is avascular with subtle rim enhancement
(arrowhead).
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Fig. 1B. —MRI of 42-year-old man with acute scrotal pain in left
testicle. Coronal T2-weighted turbo spin-echo image (5,480/140) shows lesion
with low signal intensity and well-defined borders (arrowhead).
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Fig. 2A. —Images of 38-year-old man with previous history of
epididymitis in left testicle, 1 month before. Gray-scale sonogram with linear
7-MHz transducer shows triangular lesion in left testicle (arrowhead)
with vertex pointed to rete testis.
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Fig. 2B. —Images of 38-year-old man with previous history of
epididymitis in left testicle, 1 month before. Color Doppler sonogram shows
hypovascular area with practically no flow in lesion (arrowhead);
only small vessel was seen in outer border. Rest of testicular parenchyma has
normal vasculature. Inset: T1-weighted turbo spin-echo image after
contrast use shows avascular lesion with characteristic triangular shape
(arrowhead). No changes were observed during follow-up.
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Fig. 3A. —31-year-old man with acute pain in left testicle who had
clinical symptoms of epididymoorchitis. Coronal sonogram shows round
intratesticular lesion with nondefined borders in upper pole of left testis.
Lesion was reported as testicular tumor (asterisk). MRI was also
performed.
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Fig. 3B. —31-year-old man with acute pain in left testicle who had
clinical symptoms of epididymoorchitis. Sagittal T2-weighted image (TR/TE,
3,257/120; 6-mm thickness). Arrowhead indicates the round lesion with low
signal intensity.
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Fig. 3C. —31-year-old man with acute pain in left testicle who had
clinical symptoms of epididymoorchitis. Unenhanced (C) and enhanced
(D) T1-weighted images (572/20) show findings similar in morphology but
with borders better defined than on sonography. Enhanced image also defines
avascular lesion with marked rim enhancement of borders. Lesion does not bulge
upper pole of testis, and even this upper hemisphere seems smaller than rest
of testicular parenchyma (arrowheads). Despite this finding and
negative tumoral markers, lesion could not be differentiated from tumor, and
patient underwent orchiectomy. Pathologic result was segmental testicular
infarction.
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Fig. 3D. —31-year-old man with acute pain in left testicle who had
clinical symptoms of epididymoorchitis. Unenhanced (C) and enhanced
(D) T1-weighted images (572/20) show findings similar in morphology but
with borders better defined than on sonography. Enhanced image also defines
avascular lesion with marked rim enhancement of borders. Lesion does not bulge
upper pole of testis, and even this upper hemisphere seems smaller than rest
of testicular parenchyma (arrowheads). Despite this finding and
negative tumoral markers, lesion could not be differentiated from tumor, and
patient underwent orchiectomy. Pathologic result was segmental testicular
infarction.
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Fig. 4A. —38-year-old man with hemorrhagic segmental testicular
infarction in right testicle. Patient was treated for acute scrotum and
suspicion of spermatic cord torsion. MR sagittal T1-weighted unenhanced image
shows high-signal-intensity foci in lesion due to hemorrhage
(arrowhead).
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Fig. 4B. —38-year-old man with hemorrhagic segmental testicular
infarction in right testicle. Patient was treated for acute scrotum and
suspicion of spermatic cord torsion. Sagittal enhanced T1-weighted image shows
avascular lesion, enhancement in periphery, and triangular shape
(arrow).
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Fig. 4C. —38-year-old man with hemorrhagic segmental testicular
infarction in right testicle. Patient was treated for acute scrotum and
suspicion of spermatic cord torsion. Hemorrhagic segmental testicular
infarction has heterogeneous signal intensity on coronal T2-weighted image
(arrow).
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Fig. 4D. —38-year-old man with hemorrhagic segmental testicular
infarction in right testicle. Patient was treated for acute scrotum and
suspicion of spermatic cord torsion. MR coronal T2-weighted images initially
(D) and 1 month later (E) show subtle retraction on tunica
albuginea (arrowheads) in area close to segmental testicular
infarction. This finding was also seen in three other patients who had chronic
evolution of segmental testicular infarction.
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Fig. 4E. —38-year-old man with hemorrhagic segmental testicular
infarction in right testicle. Patient was treated for acute scrotum and
suspicion of spermatic cord torsion. MR coronal T2-weighted images initially
(D) and 1 month later (E) show subtle retraction on tunica
albuginea (arrowheads) in area close to segmental testicular
infarction. This finding was also seen in three other patients who had chronic
evolution of segmental testicular infarction.
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Fig. 5B. —Images of 32-year-old man with small segmental infarction in
lower pole of right testis (arrows). Coronal T1-weighted enhanced
image shows typical enhancement of borders. Center of lesion lacks contrast
enhancement, indicating avascular zone.
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Fig. 5A. —Images of 32-year-old man with small segmental infarction in
lower pole of right testis (arrows). Coronal T2-weighted image shows
segmental testicular infarction with low signal intensity and triangular
shape.
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Fig. 5C. —Images of 32-year-old man with small segmental infarction in
lower pole of right testis (arrows). Morphology is also observed in
sonography study.
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Fig. 5D. —Images of 32-year-old man with small segmental infarction in
lower pole of right testis (arrows). In this patient, segmental
testicular infarction was suspected, but he was one of the first patients
studied and orchiectomy was performed because of our inexperience with this
disorder. A slight tunica albuginea retraction is seen in lesion periphery
(arrowhead).
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Fig. 6. —Diagrammatic representation of testicular blood supply. If
anterior epididymal artery (dotted line) is absent or its flow is
impaired (e.g., because of excessive intrascrotal movement of testis, torsion
and detorsion, unobserved interruption of arterial blood flow during
operations performed on spermatic cord within inguinal canal), then capsular
artery will be terminal vessel in upper pole of testis and is not supplied by
collaterals. This possibility may make the patient prone to a focal infarct. a
= artery.
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Copyright © 2005 by the American Roentgen Ray Society.
