Segmental testicular infarction in a 17-year-old teenager
- Authors: Shedrov D.N.1, Shormanov I.S.2, Gаrova D.Y.2, Nagornova E.Y.1
-
Affiliations:
- Yaroslavl Regional Pediatric Clinical Hospital
- Yaroslavl State Medical University
- Issue: Vol 26, No 2 (2022)
- Pages: 112-116
- Section: CLINICAL OBSERVATIONS
- Submitted: 21.06.2022
- Accepted: 21.06.2022
- Published: 21.06.2022
- URL: https://jps-nmp.ru/jour/article/view/466
- DOI: https://doi.org/10.55308/1560-9510-2022-26-2-112-116
- ID: 466
Cite item
Abstract
EDITORIAL COMMENT. According to clinical data, segmental testicular infarction occurred due to transient testicular torsion with impaired arterial blood supply. Thus, in the presented clinical case, segmental testicular infarction should not be considered as a complication of varicocele.
Introduction. Segmental testicular infarction in children and adolescents is a rare case that is mostly met as a complication of andrological or other diseases. This pathology is extremely difficult to diagnose. At the same time, in order to increase the chance for favorable outcomes, decision on the proper way of care must be taken as soon as possible.
Purpose. To demonstrate a case of successful diagnostics and treatment of segmental testicular infarction in a teenager with varicocele.
Material and methods. The patient was admitted with a picture of acute scrotum syndrome three hours later after the onset of the disease with preliminary diagnosis "testicular torsion and thrombosis of testicular veins in a patient with varicocele". Four days before, the patient consulted a urologist about pain in the left testicle. Varicocele grade III on the left without orchopathy was diagnosed. The pain syndrome was relieved by non-steroidal anti-inflammatory drugs. Previously, this pathology had not been diagnosed in this patient, and he did not suspect it. Examination of organs: no marked changes; locally, on the left, there is expansion of testicular veins of degree III; testicle on the left is painful, dense. Ultrasound examination and dopplerography of the scrotum organs were urgently made. Findings of radial examinations revealed segmental thrombosis in the middle part of the testicle; however, because of low occurrence of segmental thrombosis and greater focus on the testicular torsion the surgeons were not sure of absolute accuracy of the obtained additional findings. An emergency revision of the scrotum was performed at which the diagnosis of segmental thrombosis was confirmed. Three month later, at a follow-up examination partial restoration of blood flow in the infarction zone without pronounced signs of testicular atrophy was seen.
Conclusion. Segmental testicular infarction is an extremely rare complication of varicocele in children and adolescents. A proper assessment of the clinical picture and ultrasound imaging allow to put the well-timed and correct diagnosis of segmental testicular infarction. Not in all cases, segmental testicular infarction should be considered as an irreversible condition that leads to sclerosis in its outcome.
About the authors
D. N. Shedrov
Yaroslavl Regional Pediatric Clinical Hospital
Author for correspondence.
Email: fake@neicon.ru
Yaroslavl, 150042
РоссияI. S. Shormanov
Yaroslavl State Medical University
Email: fake@neicon.ru
Yaroslavl, 150000
РоссияD. Yu. Gаrova
Yaroslavl State Medical University
Email: dar.garova@yandex.ru
Daria Yu. Garova, clinical resident, department of pediatric surgery
Yaroslavl, 150000
РоссияE. Yu. Nagornova
Yaroslavl Regional Pediatric Clinical Hospital
Email: fake@neicon.ru
Yaroslavl, 150042
РоссияReferences
- Johnston J.H. Localised infarction of the testis. Br. J. Urol. 1960; 32: 97-9.
- Barua S.K., Bagchi P., Sharma D., Rajeev T.P., Dhekial P.P. Segmental Testicular Infarction: A Clinical Dilemma. J Genit Syst Disor. 2015; 4: 2. https://doi.org/10.4172/2325-9728.1000135
- Aquino M, Nghiem H, Jafri SZ, Schwartz J, Malhotra R and Amin M: Segmental testicular infarction: sonographic findings and pathologic correlation. J. Ultrasound Med. 2013; 32: 365–72. https://doi.org/10.7863/jum.2013.32.2.365
- Yusuf G., Sellars M.E., Kooiman G.G., Diaz-Cano S., Sidhu P.S. Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. Journal of Ultrasound in Medicine. 2013; 32: 175–80. https://doi.org/10.7863/jum.2013.32.1.175
- Kim H.K., Goske M.L., Bove K.E., Minovich E. Segmental testicular infarction in a young man simulating a testicular tumor. Pediatric Radiology. 2009; 39: 400–2. https://doi.org/10.1007/s00247-009-1148-2
- Adorisio O., Ceriati E., Camassei F.D., De Peppo F. Segmental haemorrhagic infarction of the testis in a paediatric patient: a rare aftermath of epididymitis. BMJ Case Rep. 2013; Published 2013 Jan 7. https://doi.org/10.1136/bcr-2012-007970
- Ellifranji M., Elawar A., Stafrace S., Salle J. Segmental Testicular Infarction Associated to Torsion: First Case report in Childhood. Urologj. 2021; 149: 227-9. https://doi.org/10.1016/j.urology.2020.07.056
- Penson D.F., Aaronson W. Segmental testicular infarction in the neonate: a case repost. Urol. 1995; 153: 1992- 3.
- Maitray D.P., Biren M.P. Sonographic and MRI appearance of burned out testicular germ cell neoplasia. J. Ultrasound Med. 2007; 26: 143-6. https://doi.org/10.7863/jum.2007.26.1.143
- Shiraj S., Ramani N., Wojtowycz A.R. Segmental Testicular Infarction, an Underdiagnosed Entity: Case Report with Histopathologic Correlation and Review of the Diagnostic Features. Case Reports in Radiology. 2016. https://doi.org/10.1155/2016/8741632
- Costa M., Calleja R., Ball R.Y., Burgess N. Segmental testicular infarction. B.J.U. Int. 1999; 83: 525. https://doi.org/10.1046/j.1464-410x.1999.00038.x
- Palmisano F., Serrago M., Gallioli A., Lorusso V., Gadda F., Spinelli M.G., et al. Segmental testicular infarction: Case series and brief literature review of a great mime. Urol. Ann. 2019; 11: 334-7. https://doi.org/10.4103/UA.UA_125_18
- Gianfrilli D., Isidori A.M., Lenzi A. Segmental testicular ischaemia: Presentation, management and follow-up. Int J Androl. 2009; 32: 524-31. https://doi.org/10.1111/j.1365-2605.2008.00891.x
- Bak-Ipsen C.B., Degn S., Pole L.S., Nielsen T.K., List G., Ole G. Segmental Testicular Infarction. Ultrasound Int Open. 2020; 6: 50 –2. https://doi.org/10.1055/a-1270-7795
- Onuki T., Komeya M., Okajima K., Fujinami K., Senga Y., Goto A., Asakura T. Segmental infarction of the testis presenting as acute scrotum: a case repost. Hinyokika Kiyo. 2009; 55: 281-4.
- Shen Y.-H., Lin Y.-W., Zhu X.-W., Сal B.-S., Li J., Zheng X.-Y. Segmental testicular infarction: A case report. Experimental and Therapeutic Medicine. 2015; 9: 758–60. https://doi.org/10.1056/NEJMoa1911303