testicular vasculitis
Testicular vasculitis can occur as either part of a systemic vasculitis or an isolated vasculitis involving only the testes with both having roughly equal prevalence.
Epidemiology
The mean age of onset is approximately 40 years.
Clinical presentation
Symptoms can include a testicular mass with or without pain, pain alone, an epididymal mass or can be asymptomatic altogether . The absence of physical symptoms (constitutional and musculoskeletal) and normal laboratory findings (such as ESR and FBC) are more commonly found in isolated testicular vasculitis compared to systemic testicular vasculitis .
Pathology
Etiology
Systematic diseases reported to cause testicular vasculitis are most commonly polyarteritis nodosa (~65%) and granulomatosis with polyangiitis (~20%) . However, it has also been noted to occur with rheumatoid arthritis, giant cell arteritis and Henoch-Schönlein purpura .
Radiographic features
Ultrasound
Ultrasonography is the main investigation for vasculitis of the testis and may show areas of reduced or absent testicular artery flow and a testis with a heterogeneous appearance with multiple hypoechoic mass-like areas .
Cases of infarction may reveal a solid hypoechoic mass-like area in the testicles and the absence of color Doppler flow in the affected and surrounding region .
Treatment and prognosis
In patients with no history of comorbid systematic vasculitis, these diseases should be excluded. Treatment for testicular vasculitis usually includes orchiectomy . However, in some cases where systemic treatment for an underlying vasculitic disease is commenced partial reperfusion of the testicle can occur .
Testicular infarction is a possible complication of testicular vasculitis. In one case series, 100% of patients with vasculitis had evidence of localized infarction on orchiectomy . However, in addition to segmental infarction, a variety of patterns has been reported including unilateral complete infarction and even bilateral complete infarction .
Differential diagnosis
Differential diagnoses includes :
Siehe auch:
Assoziationen und Differentialdiagnosen zu testicular vasculitis:
