Harlequin testicle and other uncommon pathologies masquerading at routine scrotal ultrasound

Our plain-English summary of Harlequin testicle and other uncommon pathologies masquerading at routine scrotal ultrasound, by J.R. Medverd, L. Peguero, D.P. Patel (Ultrasound Quarterly, 2015).

The study

• Authors: J.R. Medverd, L. Peguero, D.P. Patel
• Journal: Ultrasound Quarterly
• Published: 2015;31(2):109-16
• Type of article: Review
• Read it: PubMed · Publisher

Abstract

Many scrotal conditions manifest similarly as pain, swelling, a palpable abnormality, or a combination of these symptoms. Most common scrotal pathologies have characteristic accompanying sonographic findings. Less common pathologies can have similar clinical presentations, and imaging with scrotal ultrasound is required to aid in proper diagnosis. This article focuses on several of these less commonly encountered scrotal pathologies--including testicular segmental infarction, scrotal filariasis, scrotal mesothelioma, seminiferous tubule fibrosis, and scrotal leiomyosarcoma--and compares and contrasts them to more routine diagnoses. Familiarity with both typical and atypical scrotal conditions is necessary to make accurate diagnoses at ultrasound to guide appropriate treatment and avoid unnecessary surgery.

In plain English

This article was a pictorial essay, an illustrated teaching review, on five uncommon scrotal conditions that can look like more common problems on ultrasound: segmental testicular infarction, scrotal filariasis, scrotal mesothelioma, seminiferous tubule fibrosis, and scrotal leiomyosarcoma. It did not study a defined group of patients and gave no patient numbers. For mesothelioma of the tunica vaginalis, the lining around the testicle, the authors wrote that previous asbestos exposure is the only well-documented risk factor, citing another publication. The article did not report any patient's asbestos exposure. The authors described how this tumor may appear on ultrasound: as an infiltrative mass with thickening of the tunica vaginalis, as multiple discrete nodules, or as papillary fronds. They added that it is commonly associated with a fluid collection (hydrocele) that rapidly reaccumulates after aspiration. One illustrated case showed multiple nodules extending from the tunica vaginalis. The authors stated that definitive diagnosis is obtained after surgical excision and that radical orchiectomy is the treatment of choice. They concluded that familiarity with both typical and atypical scrotal conditions is necessary for accurate ultrasound diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pictorial essay (illustrated narrative review) of uncommon scrotal conditions seen on ultrasound
• Who was studied: No defined study population. The article is illustrated with ultrasound images from individual, unnumbered cases; it does not say how many patients, from where, or when.
• Exposure: No exposure was studied. Asbestos is mentioned only in background on mesothelioma of the tunica vaginalis, where the authors state (citing another publication) that previous asbestos exposure is the only well-documented risk factor. No fiber type is named and no patient's exposure is reported.
• Main results:
  • The authors described that mesothelioma of the tunica vaginalis may appear on ultrasound as an infiltrative mass with thickening of the tunica vaginalis, as multiple discrete nodules, or as papillary fronds of mixed echogenicity.
  • The authors stated that this mesothelioma is commonly associated with a hydrocele that rapidly reaccumulates after aspiration.
  • An illustrated case of malignant mesothelioma showed multiple paratesticular nodules extending from the tunica vaginalis.
  • The authors stated that definitive diagnosis of this mesothelioma is obtained after surgical excision.
  • The authors stated that radical orchiectomy is the treatment of choice for this mesothelioma.
  • For segmental testicular infarction (the 'harlequin testicle'), the authors described the most common ultrasound appearance as a wedge-shaped hypoechoic area.
• The authors' conclusion: The authors concluded that familiarity with both typical and atypical scrotal conditions is necessary to make accurate ultrasound diagnoses, guide appropriate treatment and avoid unnecessary surgery.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Mesothelioma, Tubule, Fibrosis.

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