title: Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up.
abstract: OBJECTIVE
  The purpose of this retrospective study was to assess whether contrast-enhanced ultrasound is useful for characterization of acute segmental testicular infarction.
  
  
  METHODS
  Twenty men with acute scrotal pain and suspected segmental testicular infarction underwent contrast-enhanced ultrasound. Three patients underwent orchiectomy. For the other patients, the final diagnosis was based on the absence of tumor markers and a change in the size or shape of the tumor during follow-up. Forty-nine color Doppler ultrasound studies (16 within 24 hours of the onset of pain; 14, 2-17 days after pain onset; 19 after 1 month or more), and 38 contrast-enhanced ultrasound studies (13 within 24 hours after pain onset; nine, 2-17 days; 16 after 1 month or more) were performed.
  
  
  RESULTS
  Fourteen of 16 lesions examined within 24 hours were oval, and two were wedge shaped. Eight lesions were isoechoic to the testis, six were hypoechoic, and two had mixed echogenicity. Twelve lesions were avascular and four were hypovascular at color Doppler examination. Contrast-enhanced ultrasound showed avascular parenchymal lobules in all cases and without perilesional rim enhancement in 12 of 13 studies. Two to 17 days after the symptoms appeared, contrast-enhanced ultrasound showed avascular lobules in all cases and perilesional rim enhancement in eight examinations. After 1 month or more, contrast-enhanced ultrasound depicted intralesional vascular spots in 12 of 14 infarcts. Perilesional enhancement was absent.
  
  
  CONCLUSIONS
  Recognition of lobular morphologic characteristics and the presence of perilesional rim enhancement at contrast-enhanced ultrasound can increase confidence in the diagnosis of segmental testicular infarction compared with reliance on gray-scale and color Doppler findings. Changes in lesion features during follow-up confirm the differential diagnosis from other testicular lesions and allow conservative management.
authors.affiliation: Department of Radiology, Ospedale di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy. bertolot@units.it
authors.forename: Michele
authors.initials: M
authors.lastname: Bertolotto
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Derchi
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.forename: Massimo
authors.initials: M
authors.lastname: Valentino
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grenier
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cova
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D010147:Pain Measurement; D010743:Phospholipids; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013459:Sulfur Hexafluoride; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride