INTRODUCTION:Testicular infarction is a rare complication of prolonged epididymitis and may be misdiagnosed as testicular torsion. In this study, we present three cases of testicular infarction and discuss their clinical characteristics, imaging features and clinical management. PATIENTS AND METHODS:Three adult males with prolonged epididymitis presented with chronic unilateral testicular pain, tenderness, and palpable swelling, including left varicocele in one case and hydrocele in the other two cases. Patient’s symptoms were not relieved after antibiotic therapy. We analyzed the diagnosis, management, and outcome of these three cases of testicular infarction resulting from prolonged epididymitis. This includes the clinical characteristics, features of color doppler ultrasound imaging for diagnosis, and treatment strategy for testicular infarction from prolonged epididymitis. RESULTS:Complete blood count (CBC) indicated a small leukocytosis (10.6±0.4×109/L; normal arrange 3.5–9.5 WBC×109/L). Color doppler images demonstrated appropriate blood flow to areas of interest at patient’s initial visit. At follow up visit several months later, the increased blood flow was detected at the edges of the involved testes with no blood flow to the center. The sizes of the involved testis (27±4 ml) was significantly larger compared to the non affected side (17±2 ml) (p < 0.05). Unilateral simple orchiectomy was performed on the involved testis in all three cases. Grossly, abscess cavities with caseous necrosis were found at the center of the testicle and epididymis in two patients. Histopathologic examination showed chronic inflammation with lymphocytic and macrophage infiltration of the involved testicle in two cases. The third case stained positive for acid fast bacteria. Left varicocele disappeared postoperatively in one patient. No pain, wound infection or other discomfort were noted 12 months after surgery. COMMENTS:This series revealed that testicular infarction may result from inappropriately treated prolonged epididymitis. Epididymal tuberculosis should be considered in cases with epididymitis not responding to broad spectrum antibiotics. Testicular infarction induced by prolonged epididymitis is easily missed due to a lack of symptom changes. Color doppler images are helpful in the diagnosis. This usually presents as a decrease in blood flow at the center of the testis with the increased flow at the periphery differentiating this from testicular torsion.

中文翻译：

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存在长期附睾炎的睾丸梗塞诊断挑战：三例报告和文献复习。

引言：睾丸梗塞是长期附睾炎的一种罕见并发症，可能被误诊为睾丸扭转。在本研究中，我们介绍了三例睾丸梗塞，并讨论了它们的临床特征、影像学特征和临床管理。患者和方法：3 名患有长期附睾炎的成年男性表现为慢性单侧睾丸疼痛、压痛和可触及的肿胀，包括 1 例左侧精索静脉曲张和另外 2 例鞘膜积液。抗生素治疗后患者症状未缓解。我们分析了这三例长期附睾炎引起的睾丸梗塞的诊断、治疗和结果。这包括临床特征、用于诊断的彩色多普勒超声成像的特征、长期附睾炎睾丸梗塞的治疗策略。结果：全血细胞计数（CBC）提示少量白细胞增多（10.6±0.4×109/L；正常排列3.5-9.5 WBC×109/L）。彩色多普勒图像在患者初次就诊时证明了流向感兴趣区域的适当血流。在几个月后的随访中，在受累睾丸的边缘检测到血流量增加，而没有血流到中心。受累睾丸的大小 (27±4 ml) 明显大于未受累侧 (17±2 ml) (p < 0.05)。三例均对受累睾丸进行单侧单纯睾丸切除术。大体上，在两名患者的睾丸和附睾中心发现了伴有干酪样坏死的脓肿腔。组织病理学检查显示 2 例受累睾丸出现慢性炎症，淋巴细胞和巨噬细胞浸润。第三个病例对耐酸细菌染色呈阳性。一名患者术后左侧精索静脉曲张消失。术后 12 个月未见疼痛、伤口感染或其他不适。评论：这个系列揭示了睾丸梗塞可能是由于长期附睾炎治疗不当引起的。如果附睾炎对广谱抗生素无反应，应考虑附睾结核。长期附睾炎诱发的睾丸梗塞，由于缺乏症状变化，很容易被漏诊。彩色多普勒图像有助于诊断。