特発性精巣梗塞の1例

Abstract

20歳男性.患者は右陰嚢腫大, 陰嚢内痛の悪化で受診となった.所見では, 右精巣, 精巣上体が鶏卵大に腫大し圧痛を認め, WBC, CRPの上昇を認めた.超音波検査では右精巣全体の腫大と内部に不均一な低エコー像を認め, 右精巣上体の腫大と陰嚢壁の肥厚が認められた.一方, CTでは右精巣は腫大し内部濃度は均一であり, MRIでは右精巣は43×38×28mmと腫大し, T1強調でやや高信号, T2強調で不均一な高信号を呈していた.精巣捻転, 精巣腫瘍を疑い, 高位精巣摘除術を施行したところ, 精巣に捻転は認めず, 血栓形成など異常は認めなかった.病理所見では, 精巣・精巣上体は高度に出血壊死しており, 周囲静脈の内腔は拡張し鬱血していた.悪性所見は認められず, 原因不明から特発性の精巣梗塞と診断した.術後経過は良好で4日後に退院となった

We herein report a case of idiopathic testicular infarction. The patient was a 20-year-old man with the chief complaint of right testicular swelling and pain. Ultrasonography and color Doppler sonography demonstrated a hypoechoic lesion without any blood supply. Torsion of the right spermatic cord was most suspected, but we could not exclude the possibility of testicular cancer judging from the findings obtained by computed tomography and magnetic resonance imaging. Surgical exploration did not reveal any torsion of the spermatic cord. Subsequently, right high orchiectomy was performed because of the risk of a testicular cancer. Histopathological examination revealed a hemorrhage and congestion of the testis and epididymis.