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.

Case Report: Segmental Testicular Infarction

Segmental testicular infarction is a rare condition that presents with acute testicular pain. The diagnosis can be clinically challenging and include important differential diagnoses such as testicular torsion, testicular tumour and infection. This case report describes a 27-year-old male presenting to a regional Australian hospital with acute left testicular pain. The diagnosis was made intra-operatively during surgical exploration and on histopathologic assessment after the patient underwent a partial orchidectomy. While segmental testicular infarction is a rare condition, it should be considered in the differential diagnosis for acute testicular pain as awareness may help to avoid unnecessary radical surgery.