Segmental Testicular Infarction: Clinical Course and Added Value of Contrast-Enhanced Ultrasound Findings-Case Report

Segmental testicular infarction (STI) is a rare, benign condition that often mimics testicular tumours, leading to diagnostic challenges and, at times, unnecessary orchiectomies. The clinical challenge is the lack of a consensus regarding which imaging tools should be used to characterise the testicular lesions and which one is the most reliable.

We report the case of a 34-year-old man presenting at the emergency department with right testicular pain and swelling. Contrast-enhanced ultrasound (CEUS) performed at our hospital revealed a poorly defined, hypoechoic lesion with peripheral rim enhancement, consistent with subacute infarction. Follow-up CEUS 1 month later showed reduction in lesion size and absence of enhancement, supporting a benign evolution. However, surgical exploration was performed because of the impossibility to fully exclude malignancy. Intraoperative frozen-section analysis confirmed haemorrhagic infarction with no signs of malignancy.

CEUS plays a central role in guiding diagnosis and follow-up, offering detailed assessment of testicular perfusion. Compared with conventional ultrasound and magnetic resonance imaging, CEUS is faster, safer, more cost-effective and highly accurate in differentiating infarction from hypovascular tumours. This case study supports the growing use of CEUS as a first-line imaging modality in the evaluation of testicular lesions, promoting conservative management and avoiding overtreatment in appropriate clinical settings.