Lecture Notes: Testicular Conditions and Imaging

Introduction

• The testicular parenchyma can suffer vascular insult in two ways:
  • Torsion: Involves the whole testis.
  • Focal Infarction: Affects a specific area.

Testicular Torsion

• Occurs in men with a "bell-clapper" deformity.
• The deformity causes the testis to swing, obstructing blood flow.
• Salvage Rate:
  • < 6 hours: Excellent chance of saving the testis.
  • 6-24 hours: Decreased salvageability.

  • 24 hours: Poor chance of salvage.

• Symptoms & Diagnosis:
  • Absent or decreased blood flow in affected testis.
  • Testis may become enlarged, edematous, and heterogeneous after 4 hours.
  • After 24 hours, often termed "missed torsion," with no blood flow and scrotal wall changes.

Focal Infarction

• Often occurs in older patients, presenting with acute pain.
• Appears as a wedge-shaped hypoechoic area or a mass on ultrasound.
• Masses are concerning for malignancy but may be infarctions.

Other Conditions

Testicular Trauma

• Types:
  • Contusion: Hypoechoic lesions with poorly defined margins.
  • Fracture: Hypoechoic band across the testis.
  • Rupture: Disruption of the testicular capsule.
• Imaging: Ultrasound shows hematomas and disruptions.

Cystic Lesions

• Types:
  • Testicular cysts: Benign, often asymptomatic.
  • Epidermoid cysts: Show an onion-skin appearance.
  • Tubular ectasia: Obstruction-related cystic spaces.
  • Epididymal cysts and spermatoceles: Benign, may cause discomfort.

Microlithiasis

• Tiny calcifications scattered in the testicular parenchyma.
• Increases risk for germ cell tumors.
• Graded by the number of calcifications seen.

Varicocele

• Dilation of the pampiniform plexus veins, often affecting fertility.
• Common Features:
  • More frequent on the left side.
  • Diagnosed with ultrasound showing dilated veins and reflux during Valsalva.

Hydrocele

• Accumulation of fluid in the tunica vaginalis.
• Types:
  • Communicating: Fluid surrounds the testis.
  • Spermatic cord hydrocele: Fluid along the spermatic cord.
  • Diagnosed via ultrasound.

Testicular Atrophy

• Characterized by diminished size and function.
• Causes include trauma, infection, varicocele, etc.
• Diagnosed by ultrasound showing reduced volume and heterogeneous texture.

Testicular Sarcoidosis

• Rare, involves lesions in multiple organs.
• Presentation:
  • Painless mass, often bilateral.
  • Can mimic malignancy on ultrasound.

Conclusion

• Identifying these conditions via imaging is crucial for proper diagnosis and treatment.