IMAGING

Radiologic findings of segmental testicular infarction
Fernandez-Perez GC, Tardaguila FM, Velasco M, Rivas C, Dos Santos J, Cambronero J, Trinidad C, San Miguel P
Radiology Department, Povisa Medical Center, Vigo (Pontevedra), Spain
AJR Am J Roentgenol. 2005; 184: 1587-93

• Objective: Our objective was to describe the radiologic findings of segmental testicular infarction and to establish a proper diagnosis that can avoid orchiectomy.
• Conclusion: The presence of a triangular-shaped avascular intratesticular lesion on sonography or MRI and enhancement of the surrounding borders on enhanced MR images may suggest a presurgical diagnosis of segmental testicular infarction and therefore avoid a total orchiectomy in these patients.
  
  
• Editorial Comment
  The authors present interesting imaging findings observed in 12 patients with a relatively rare testicular disorder such is segmental testicular infarction. This condition which usually presents as an acute scrotum and may be associated with epididymoorchitis, hematologic disorders, vasculitis and postoperative changes, is usually diagnosed only after orchiectomy. In this series, an acute scrotum was the most frequent clinical presentation, being observed in 8 of 12 patients (67%). Ultrasound findings were very suggestive of this entity (solid and wedge shaped avascular area on color Doppler examination, with the vertex at the testicular mediastinum). Occasionally, however, a small rounded solid mass simulating an intratesticular tumor was observed. On contrast enhanced T1-weighted MR images, segmental testicular infarction showed an enhanced rim surrounding the lesion in 92 % of patients. This paper is very important for calling the attention of the radiologist and urologist in order to recognize segmental testicular infarction and thus to avoid unnecessary orchiectomy. The authors concluded that these imaging findings (ultrasound and complimentary MRI in difficult cases), associated with the negative tumoral markers and short follow-up, should allow confidence in the diagnosis and thus avoid orchiectomy.

Dr. Adilson Prando
Chief, Department of Radiology
Vera Cruz Hospital
Campinas, São Paulo, Brazil