Case discussion
01Clinical context
A male patient underwent scrotal ultrasound for infertility evaluation. The study included gray-scale and color Doppler imaging of both testes and associated structures.
02Key imaging findings
The right testis shows a well-circumscribed, heterogeneous intratesticular lesion in the upper pole measuring 0.83 × 0.52 cm with internal echogenic/calcific components and prominent internal and peripheral vascularity on color Doppler. The left testis is normal. A moderate left hydrocele and a clinically significant left varicocele with dilated pampiniform plexus veins up to 4 mm and reflux on Valsalva maneuver are present. No evidence of testicular rupture or torsion; bilateral testicular perfusion is preserved.
03Diagnostic reasoning
The diagnosis was established using high-resolution gray-scale ultrasound to identify the lesion's size, location, and echotexture. Color Doppler imaging demonstrated prominent internal and peripheral vascularity, supporting a solid hypervascular mass rather than cystic or avascular lesion. The presence of internal echogenic/calcific foci further suggested neoplastic etiology. Concurrent evaluation of the pampiniform plexus veins with Doppler during Valsalva maneuver confirmed the left varicocele. Hydrocele was identified as an anechoic fluid collection around the left testis.
04Questions for clinical practice
What is the significance of the hypervascular intratesticular mass? It is suspicious for a primary testicular tumor, most commonly a germ-cell tumor, and requires urologic referral for further evaluation and management. How urgent is further workup? Prompt assessment is recommended due to the risk of malignancy. Does the varicocele affect fertility? Yes, significant varicoceles can impair testicular function and contribute to infertility. What is the role of ultrasound in this context? Ultrasound with color Doppler is the first-line imaging modality to characterize testicular lesions and vascular abnormalities.
05Teaching point
A small hypervascular intratesticular mass with internal calcifications on ultrasound should raise suspicion for a primary testicular neoplasm, most commonly germ-cell tumors. Color Doppler is essential to assess vascularity and exclude torsion. Concurrent varicocele and hydrocele can coexist and should be reported for comprehensive clinical management.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.