Sonographic Discovery of Segmental Testicular Infarction

The prevalence of segmental testicular infarction is extremely uncommon and very few cases have been reported in literature. Clinical and sonographic presentation of this condition can mimic testicular neoplasms or testicular torsion. Therefore, accurate diagnosis of segmental testicular infarction is imperative in the treatment process. This case study presents the sonographic diagnosis of testicular infarction in a 49-year-old man who reported mild testicular tenderness. A conservative treatment approach was used, saving the patient unnecessary surgical intervention.

1647 A Rare Case of Segmental Testicular Infarct and Subsequent Investigations

Segmental testicular infarction (STI) is a very rare condition, with less than 70 cases reported since 1909. It generally presents with testicular pain and may be confused clinically with testicular torsion and radiologically with testicular cancer. However, it can be managed conservatively, unlike those diagnoses, so in order to avoid unnecessary treatment it should be considered as a differential in presentations of testicular pain. The etiology of STI is most commonly idiopathic (70% of cases), but it is important to rule out underlying infection, clotting disorders or vasculitis. As a result, whenever this diagnosis is made, it is vital to carry out further investigations. This case concerns a 36-year-old chef, with no significant past medical history, who presented with a 24-hour history of severe testicular pain. Due to the length of time from onset of symptoms, he underwent routine blood tests, urinalysis and an ultrasound rather than proceeding to scrotal exploration. This showed a wedge-shaped hypoechoic area in keeping with segmental infarct. As a result, he was managed conservatively, but subsequently had further specialist blood tests, as well as computed tomography imaging and several interval ultrasounds. No cause was found and after several months, while the hypoechoic area seen on ultrasound was still present, his pain had resolved. While this a rare cause of testicular pain, it is important to consider it as a diagnosis, as it may avoid an unnecessary operation. Subsequent investigations are complex, so it is important to appreciate their necessity.

Hemorrhagic testicular infarction as a complication of COVID-19 (SARS-CoV-2)

Introduction. Statistically, adult patients with testicular infarction make up 7-10% of the population of all acute urological pathology. This is one of the urological nosologies, which is а part of a group of diseases called acute scrotum . Ischemic heart attack occurs as a result of an acute violation of the blood supply to the testicle from the testicular artery. Hemorrhagic infarction usually occurs as a result of impaired microcirculation or embolization of the arteries and arterioles of the testicle and is most often segmental in nature. Conditions associated with increased blood clotting also create conditions for vein obstruction with subsequent tissue necrosis in any organ, including in the testicles. It is known that COVID-19 (SARS-COV-2) causes a pathological increase in blood clotting in the patient's body and it's most dangerous complication is thrombosis in various blood vessels of the patient's organs, which often causes acute ischemia of these organs and even death in patients with COVID 19. Materials and methods. The authors consider 3 similar clinical observations of hemorrhagic testicular infarction in patients suffering from COVID-19 (SARS-COV-2) and who were in the specialized COVID department of the city hospital of Pyatigorsk (Russia, Stavropol Territory). All 3 patients were aged from 67 to 88 years and had a concomitant pathology from the cardiovascular system in the form of arterial hypertension, as well as type 2 diabetes mellitus. The authors provide one case in detail, since all 3 cases followed the same clinical scenario. Clinical observation: Patient B. 66 years old, who was in a specialized COVID department with a diagnosis of: Coronovirus infection caused by COVID 19 (confirmed), moderate form of UO7. 1, community-acquired bilateral lobar pneumonia, acute respiratory distress syndrome, respiratory failure. Concomitant diseases: atherosclerotic cardiosclerosis, arterial hypertension, type 2 diabetes mellitus. The patient received therapy for the underlying disease, but on the 9th day of his stay in the hospital, he had an acute hemorrhagic infarction of the left testicle. The diagnosis was confirmed by laboratory and instrumental examination. An emergency left-sided orchectomy was performed, and the diagnosis was confirmed histologically. Similar clinical situations were observed in two other patients with the same outcome. Conclusions. Hemorrhagic testicular infarction in patients with COVID-19 in our clinical observation can be considered as a complication of COVID-19, or as its clinical manifestation in the organs of the male reproductive system.

SARS-CoV-2-Associated Obliterative Arteritis Causing Massive Testicular Infarction

A 26-year-old man with symptomatic SARS-CoV-2 infection developed a sudden-onset acute testicular pain. The echo-doppler images showed massive testicular infarction, so orchiectomy was performed. On gross examination, the surgical specimen showed complete testicular necrosis and diffuse thickening of the testicular coverings. Under the microscope, a severe obliterative arteritis was evidenced. SARS-CoV-2 spike antibody was detected by immunohistochemistry in the arterial endothelium. Electron microscopy displayed intracytoplasmic spiky viral particles in endothelial cells. The patient was treated with corticoids and was asymptomatic at last contact.