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Pathologically proven cholesterol crystal embolism causing testicular infarction after endovascular aneurysm repair
Kenjiro Kaneko1, Takao Ohki2, Eisaku Ito1
1Division of Vascular Surgery, Department of Surgery, Shinyurigaoka General Hospital, Kanagawa, Japan.
Abstract:
Testicular infarction following endovascular aneurysm repair (EVAR) is extremely rare, and its pathogenesis remains unclear. We report a 56-year-old man who developed acute right testicular infarction after EVAR with concomitant internal iliac artery coil embolization for an infrarenal abdominal aortic aneurysm. Pain migrated atypically from the epigastrium to the right testicle. Doppler ultrasound study suggested ischemia, and contrast-enhanced magnetic resonance imaging confirmed global infarction. Orchiectomy revealed cholesterol crystal embolism in the spermatic cord artery. This case highlights the utility of magnetic resonance imaging for diagnosing post-EVAR testicular infarction and emphasizes the importance of early scrotal evaluation in patients presenting with unexplained or migrating postoperative pain.
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