Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.
NistalM, PaniaguaR, González-PeramatoP, Reyes-MúgicaM.Perspectives in pediatric pathology, chapter 12. Congenital epididymal anomalies. Pediatr Dev Pathol2016;19:12–23.
2.
DelasiauveLJF.Descente tardive du testicule gauche, prise pour une hernie etrangle. Rev Med Fr Etrang1840;363–375.
3.
BennettS, NicholsonMS, LittleTM.Torsion of the testis: why is the prognosis so poor?Br Med J (Clin Res Ed)1987;294:824.
4.
NistalM, AlcobaM, ContrerasF.Torsion del cordon espermatico. A proposito de 87 nuevos casos. Revision de la literatura. Arch Esp Urol1971;385–398.
5.
DavolP, SimmonsJ.Testicular torsion in a 68-year-old man. Urology2005;66:195.
6.
KattanS.Spermatic cord torsion in adults. Scand J Urol Nephrol1994;28:277–329.
7.
LeeLM, WrightJE, McLoughlinMG.Testicular torsion in the adult. J Urol1983;130:93–94.
8.
LonderganTA.Testicular torsion in a 59-year-old man. J Urol1995;154:1480.
9.
WitheringtonR, JarrellTS.Torsion of the spermatic cord in adults. J Urol1990;143:62–63.
10.
ZhaoLC, LautzTB, MeeksJJ, MaizelsM.Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of CareJ Urol2011;186:2009–2013.
11.
SkoglundRW, McRobertsJW, RagdeH.Torsion of the spermatic cord: a review of the literature and an analysis of 70 new cases. J Urol1970;104:604–607.
12.
AndersonJB, WilliamsonRC.Testicular torsion in Bristol: a 25-year review. Br J Surg1988;75:988–992.
13.
MansbachJM, ForbesP, PetersC.Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med2005;159:1167–1171.
PaciosJC Lopez, MuntanerL Parra, FernandezMC PineiroTorsiones del cordon testicular en la comarca del Bierzo. Analisis clinico-epidemiologico del quinquenio 1994–1998. Arch Esp Urol1999;835–838.
17.
OlivaresP, TovarJA.Torsion del testiculo en el recien nacido. An Esp Pediatr1976;489–492.
18.
BagciS, BachourH, WoelfleJF, MuellerA, BartmannP, FranzAR.Bilateral perinatal testicular torsion in an infant: a rare neonatal emergency. Pediatr Int2010;52:e227–e228.
19.
BarcaPR, DargalloT, JardonJA, EstevezE, BautistaA, CivesR. VarelaBilateral testicular torsion in the neonatal period. J Urol1997;158:1957–1959.
20.
KossowAS.Bilateral synchronous testicular torsion: a case report. J Urol1994;152:1211–2.
21.
SachwitzD, HassHJ, KrauseH.Bilateral intrauterine testicular torsion in a newborn [in German]. Urologe A2012;51:60–62.
22.
WashowichTL.Synchronous bilateral testicular torsion in an adult. J Ultrasound Med2001;20:933–935.
23.
WorkmanSJ, KoganBA.Old and new aspects of testicular torsion. Semin Urol1988;6:146–157.
24.
ShefiS, HaskelY.Simultaneous bilateral testicular torsion in an adult. J Urol1998;159:206–207.
ShteynshlyugerA, FreyleJ.Familial testicular torsion in three consecutive generations of first-degree relatives. J Pediatr Urol2011;7:86–91.
27.
SinisiAA, Di FinizioB, LettieriFLate gonadal function and autoimmunization in familial testicular torsion. Arch Androl1993;30:147–152.
28.
ThurstonA, WhitakerR.Torsion of testis after previous testicular surgery. Br J Surg1983;70:217.
29.
Van GlabekeE, FerhiK, MaloumC.Torsion of spermatic cord: can we trust a previous orchidopexy? A case report with loss of a single testis with medico-legal issue [in French]. Prog Urol2010;20:657–659.
30.
de VylderAM, BreeuwsmaAJ, van DrielMF, FonteyneE, NijmanJM.Torsion of the spermatic cord after orchiopexy. J Pediatr Urol2006;2:497–499.
31.
CaesarRE, KaplanGW.Incidence of the bell-clapper deformity in an autopsy series. Urology1994;44:114–116.
32.
DurandL, PerrinP.Les torsions du testicule. Ann Urol1977;11:15–20.
SrinivasanA, CinmanN, FeberKM, GitlinJ, PalmerLS.History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff. J Pediatr Urol2011;7:470–474.
61.
KelalisPP, SticklerGB.The painful scrotum: torsion vs epididymo-orchitis. Clin Pediatr (Phila)1976;15:220–221.
62.
YangCJr, SongB, LiuX, WeiGH, LinT, HeDW.Acute scrotum in children: an 18-year retrospective study. Pediatr Emerg Care2011;27:270–274.
63.
ChingCB, JonesJS.Incomplete prenatal torsion of the testicle—a successful salvage. Urology2011;78:1182–1184.
CuckowPM, FrankJD.Torsion of the testis. BJU Int2000;86:349–353.
66.
GuntherP, SchenkJP, WunschRAcute testicular torsion in children: the role of sonography in the diagnostic workup. Eur Radiol2006;16:2527–2532.
67.
IuchtmanM, ZoireffL, AssaJ.Doppler flowmeter in the differential diagnosis of the acute scrotum in children. J Urol1979;121:221–222.
68.
KravchickS, CytronS, LeiboviciOColor Doppler sonography: its real role in the evaluation of children with highly suspected testicular torsion. Eur Radiol2001;11:1000–1005.
69.
MilenaG Lopez, BenitezA Medina, HerreraR Ortega, EspigaresJ Rabaza, ManjónMI Romero, Hernández AbadMJ.Usefulness of Doppler-color ultrasonography and identification of resistance indexes as early indicators of testicular infarction secondary to orchiepididymitis [in Spanish]. Actas Urol Esp2000;24:43–47.
70.
OlderRA, WatsonLR.Ultrasound diagnosis of testicular torsion: beware the swollen epididymis. J Urol1997;157:1369–1370.
71.
RicciP, CantisaniV, DrudiFMPrenatal testicular torsion: sonographic appearance in the newborn infant. Eur Radiol2001;11:2589–2592.
72.
RodriguezDD, RodriguezWC, RiveraJJ, RodriguezS, OteroAA.Doppler ultrasound versus testicular scanning in the evaluation of the acute scrotum. J Urol1981;125:343–346.
73.
LutzkerLG.The fine points of scrotal scintigraphy. Semin Nucl Med1982;12:387–393.
74.
WuHC, SunSS, KaoA, ChuangFJ, LinCC, LeeCC.Comparison of radionuclide imaging and ultrasonography in the differentiation of acute testicular torsion and inflammatory testicular disease. Clin Nucl Med2002;27:490–493.
75.
SkoglundRW, McRobertsJW, RagdeH.Torsion of testicular appendages: presentation of 43 new cases and a collective review. J Urol1970;104:598–600.
76.
Aynsley-GreenA, ZachmannM, IlligR, RampiniS, PraderA.Congenital bilateral anorchia in childhood: a clinical, endocrine and therapeutic evaluation of twenty-one cases. Clin Endocrinol (Oxf)1976;5:381–391.
77.
MikuzG.Testicular torsion: simple grading for histological evaluation of tissue damage. Appl Pathol1985;3:134–139.
78.
NistalM, MartinezC, PaniaguaR.Primary testicular lesions in the twisted testis. Fertil Steril1992;57:381–386.
ArdaIS, OzyaylaliI.Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery. BJU Int2001;87:89–92.
84.
TryfonasG, ViolakiA, TsikopoulosGLate postoperative results in males treated for testicular torsion during childhood. J Pediatr Surg1994;29:553–556.
85.
SirventJJ, BernatR, NavarroMA, TolraJ Rodriguez, GarciaB, SalvadoMT.Spermatic cord torsion: morphologic and functional study, with special reference to the Leydig cells [in Spanish]. Actas Urol Esp1988;12:443–448.
86.
CornelEB, KarthausHF.Manual derotation of the twisted spermatic cord. BJU Int1999;83:672–674.
87.
HaynesBE, HaynesVE.Manipulative detorsion: beware the twist that does not turn. J Urol1987;137:118–119.
88.
LiskCH, WildingRP.Torsion of the testicle in homozygous twins. Br J Urol1984;56:544–5.
89.
DaehlinL, UlsteinM, ThorsenT, HoisaeterPA.Follow-up after torsion of the spermatic cord. Scand J Urol Nephrol Suppl1996;179:139–142.
90.
Van der PoelJ.Strangulation of the testis and epididymis from torsion of the spermatic cord. Med Rec1895;47:742.
91.
RigbyHM, HowardRJ.Torsion of the testis. Lancet1907;2:1415–1416.
92.
HaynMH, HerzDB, BellingerMF, SchneckFX.Intermittent torsion of the spermatic cord portends an increased risk of acute testicular infarction. J Urol2008;180 (4 Suppl):1729–1732.
93.
WhiteWM, BrewerME, KimED.Segmental ischemia of testis secondary to intermittent testicular torsion. Urology2006;68:670–671.
94.
JonesDJ.Recurrent subacute torsion: prospective study of effects on testicular morphology and function. J Urol1991;145:297–299.
WiedemannA, ZienkiewiczT.Seminoma necrosis by testicular torsion [in German]. Urologe A2010;49:84–87.
100.
LewisRL, RollerMD, ParraBL, CotlarAM.Torsion of an intra-abdominal testis. Curr Surg2000;57:497–499.
101.
ShirakawaH, KozakaiN, SugiuraH, HaraS.Torsion of a testicular cancer in cryptorchidism prolapsing out of the inguinal canal: a case report [in Japanese]. Hinyokika Kiyo2009;55:783–785.
102.
UemuraM, NishimuraK, HiraiT, InoueH, MizutaniS, MiyoshiSUndescended testicular tumor found by torsion of the testis: a case report [in Japanese]. Hinyokika Kiyo2001;47:437–439.
103.
NistalM, Gonzalez-PeramatoP, PaniaguaR.Lipomembranous fat necrosis in three cases of testicular torsion. Histopathology2001;38:443–447.
104.
PoppitiRJJr, MarguliesM, CabelloB, RywlinAM.Membranous fat necrosis. Am J Surg Pathol1986;10:62–69.
NasuT, TsukaharaY, TerayamaK.A lipid metabolic disease—“membranous lipodystrophy”—an autopsy case demonstrating numerous peculiar membrane-structures composed of compound lipid in bone and bone marrow and various adipose tissues. Acta Pathol Jpn1973;23:539–558.
RomeoC, ImpellizzeriP, ArrigoTLate hormonal function after testicular torsion. J Pediatr Surg2010;45:411–413.
109.
AndersonJB, WilliamsonRC.Fertility after torsion of the spermatic cord. Br J Urol1990;65:225–230.
110.
AndersonMJ, DunnJK, LipshultzLI, CoburnM.Semen quality and endocrine parameters after acute testicular torsion. J Urol1992;147:1545–1550.
111.
GoldwasserB, WeissenbergR, LunenfeldB, NativO, ManyM.Semen quality and hormonal status of patients following testicular torsion. Andrologia1984;16:239–243.
112.
KrarupT.The testes after torsion. Br J Urol1978;50:43–46.
113.
MerimskyE, RockM, KatzS.Assessment of fertility after testicular torsion: an experimental study. Urol Rex1982;10:51–54.
114.
ThomasWE, CooperMJ, CraneGA, LeeG, WilliamsonRC.Testicular exocrine malfunction after torsion. Lancet1984;2:1357–1360.
115.
VisserAJ, HeynsCF.Testicular function after torsion of the spermatic cord. BJU Int2003;92:200–203.
116.
ZepnickH, MatzM, KusterP, SommerG.Testicular torsion and fertility—analysis of 63 treated cases [in German]. Z Arztl Fortbild (Jena)1988;82:83–85.
117.
TaskinenS, TaskinenM, RintalaR.Testicular torsion: orchiectomy or orchiopexy?J Pediatr Urol2008;4:210–213.
118.
IchikawaT, KitagawaN, ShisekiY, SumiyaH, ShimazakiJ.Testicular function after spermatic cord torsion [in Japanese]. Hinyokika Kiyo1993;39:243–248.
119.
HadziselimovicF, SnyderH, DuckettJ, HowardsS.Testicular histology in children with unilateral testicular torsion. J Urol1986;136 (1 Pt 2):208–210.
120.
ChakrabortyJ, HikimAP, JhunjhunwalaJS.Stagnation of blood in the microcirculatory vessels in the testes of men with varicocele. JAndrol1985;6:117–126.
121.
CerasaroTS, NachtsheimDA, OteroF, ParsonsCL.The effect of testicular torsion on contralateral testis and the production of antisperm antibodies in rabbits. J Urol1984;132:577–579.
122.
NaglerHM, WhiteRD.The effect of testicular torsion on the contralateral testis. J Urol1982;128:1343–1348.
123.
RyanPC, WhelanCA, GaffneyEF, FitzpatrickJM.The effect of unilateral experimental testicular torsion on spermatogenesis and fertility. Br J Urol1988;62:359–366.
WilliamsonRC, ThomasWE.Sympathetic orchidopathia. Ann R Coll Surg Engl1984;66:264–266.
126.
JohnsonMH.An immunological barrier in the guinea-pig testis. J Pathol1970;101:129–139.
127.
CosentinoMJ, NishidaM, RabinowitzR, CockettAT.Histological changes occurring in the contralateral testes of prepubertal rats subjected to various durations of unilateral spermatic cord torsion. J Urol1985;133:906–911.
128.
KosarA, KupeliB, AlcigirG, AtaogluH, SaricaK, KupeliS.Immunologic aspect of testicular torsion: detection of antisperm antibodies in contralateral testicle. Eur Urol1999;36:640–644.
129.
FraserI, SlaterN, TateC, SmartJG.Testicular torsion does not cause autoimmunization in man. Br J Surg1985;72:237–238.
AkgurFM, KilincK, TanyelFC, BuyukpamukcuN, HicsonmezA.Ipsilateral and contralateral testicular biochemical acute changes after unilateral testicular torsion and detorsion. Urology1994;44:413–418.
132.
AkgurFM, KilincK, AktugT.Is ipsilateral testis mandatory for the occurrence of contralateral intratesticular biochemical changes indicative of hypoxia after unilateral spermatic cord torsion?Eur Urol1995;28:143–146.
133.
CiftciAO, MuftuogluS, CakarN, TanyelFC.Histological evidence of decreased contralateral testicular blood flow during ipsilateral testicular torsion. Br J Urol1997;80:783–786.
134.
KaraguzelG, TanyelFC, KilincK, BuyukpamukcuN, HicsonmezA.The preventive role of chemical sympathectomy on contralateral testicular hypoxic parameters encountered during unilateral testicular torsion. Br J Urol1994;74:507–510.
135.
TanyelFC, AydinA, BanogluE, IsimerA, BuyukpamukcuN.Noradrenaline and nitrite-nitrate concentrations in the contralateral testes during ipsilateral spermatic cord torsion in the presence or absence of a testis and epididymis. BJU Int1999;83:833–836.
136.
KolettisPN, StoweNT, InmanSR, ThomasAJJr.Acute spermatic cord torsion alters the microcirculation of the contralateral testis. J Urol1996;155:350–354.
137.
SalmanAB, MutluS, IskitAB, GucMO, MutluM, TanyelFC.Hemodynamic monitoring of the contralateral testis during unilateral testicular torsion describes the mechanism of damage. Eur Urol1998;33:576–580.
138.
SalmanAB, OkurDH, TanyelFC.DNA flow cytometry reveals depressed spermatogenetic activity in the contralateral testis within 24 h of ipsilateral spermatic cord torsion independently of the presence of the testis and epididymis. Eur Urol1998;34:377–381.
139.
HadziselimovicF, GenetoR, EmmonsLR.Increased apoptosis in the contralateral testes of patients with testicular torsion as a factor for infertility. J Urol1998;160 (3 Pt 2):1158–1160.
140.
AbesM, SarihanH, DegerO, UyduHA.The effect of ATP-MgCl on prevention of reperfusion injury after unilateral testicular torsion. Eur J Pediatr Surg2001;11:255–258.
141.
ReyesJG, FariasJG, Henriquez-OlavarrietaSThe hypoxic testicle: physiology and pathophysiology. Oxid Med Cell Longev2012;2012:929285.
ShiraishiK, NaitoK, YoshidaK.Nitric oxide promotes germ cell necrosis in the delayed phase after experimental testicular torsion of rat. Biol Reprod2001;65:514–521.
144.
ShiraziM, NoorafshanA, Karbalay-DoustS, ArdeshiriM, AfrasiabiMA, MonabatiA.Comparison of the protective effects of papaverine, lidocaine and verapamil on the sperm quality of the testis after induced torsion-detorsion in rats. Scand J Urol Nephrol2010;44:133–137.
145.
DominguezC, VerduchM Martinez, EstornellF, GarciaF, HernandezM, Garcia-IbarraF.Histological study in contralateral testis of prepubertal children following unilateral testicular torsion. Eur Urol1994;26:160–163.
146.
HoricaCA, HadziselimovicF, KreutzG, BandhauerK.Ultrastructural studies of the contorted and contralateral testicle in unilateral testicular torsion. Eur Urol1982;8:358–362.
147.
LaorE, FischH, TennenbaumS, SesterhennI, MostofiK, ReidRE.Unilateral testicular torsion: abnormal histological findings in the contralateral testis—cause or effect?Br J Urol1990;65:520–523.
148.
IshizukaE, IwasakiA, KawasakiC, FujiiH, ShuinT, FukuokaH.Anatomic comparison of the ipsilateral and the contralateral testis in intravaginal torsion. Scand J Urol Nephrol1995;29:207–209.
149.
FischH, LaorE, ReidRE, ToliaBM, FreedSZ.Gonadal dysfunction after testicular torsion: luteinizing hormone and follicle-stimulating hormone response to gonadotropin releasing hormone. J Urol1988;139:961–964.
150.
AndersonJB, CooperMJ, ThomasWE, WilliamsonRC.Impaired spermatogenesis in testes at risk of torsion. Br J Surg1986;73:847–849.
151.
StraussS, FaingoldR, ManorH.Torsion of the testicular appendages: sonographic appearance. J Ultrasound Med1997;16:189–192; quiz 93–94.
152.
MongaM, ScarperoHM, OrtenbergJ.Metachronous bilateral torsion of the testicular appendices. Int J Urol1999;6:589–591.
153.
WatkinNA.Metachronous torsion of the appendix testis. Br J Urol1995;75:117.
154.
CollieMH, McNeillAD, AndersonJH.Metachronous torsion of the appendix testis. Br J Urol1994;73:211.
155.
HollandAJ, BoucautHA, RichardsJC.Synchronous torsion of testicular appendages: a rare mechanical cause of bilateral scrotal pain. Pediatr Surg Int1999;15:519–520.
156.
MumtazFH, KhanMA, MorganRJ.Synchronous bilateral torsion of the appendix testis. Urol Int1998;60:128–129.
157.
AltafferLF3rd, SteeleSMJr.Torsion of testicular appendages in men. J Urol1980;124:56–57.
158.
KadishHA, BolteRG.A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics1998;102 (1 Pt 1):73–76.
159.
RakhaE, PulsF, SaidulI, FurnessP.Torsion of the testicular appendix: importance of associated acute inflammation. J Clin Pathol2006;59:831–834.
160.
ParkSJ, KimHL, YiBH.Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to the time from onset. J Ultrasound Med2011;30:1391–1396.
161.
MaasC, Muller-HansenI, FlechsigH, PoetsCF.Acute scrotum in a neonate caused by renal vein thrombosis. Arch Dis Child Fetal Neonatal Ed2011;96:F149–F150.
162.
SengYJ, MoissinacK.Trauma induced testicular torsion: a reminder for the unwary. J Accid Emerg Med2000;17:381–382.
163.
TsaiHN, WuWJ, HuangSP, ChenCC, WangCJ, ChouYHBilateral traumatic testicular dislocation—a case report. Kaohsiung J Med Sci2002;18:95–98.
NistalM, PaniaguaR, González-PeramatoP, Reyes-MúgicaM.Perspectives in pediatric pathology, chapter 23. Testicular pathology secondary to physical and chemical injury. Pediatr Dev Pathol In press.
166.
WantzGE.Testicular atrophy as a sequela of inguinal hernioplasty. Int Surg1986;71:159–163.
167.
RutledgeRH.Cooper's ligament repair for adult groin hernias. Surgery1980;87:601–10.
168.
FongY, WantzGE.Prevention of ischemic orchitis during inguinal hernioplasty. Surg Gynecol Obstet1992;174:399–402.
169.
RonkaK, VironenJ, KokkiH, LiukkonenT, PaajanenH.Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre. Hernia2015;19:53–59.
170.
BorleyNC, KimberC, RansleyPG.An unusual cause of testicular ischaemia. BJU Int2000;85:971.
171.
CampagnolaS, FlessatiP, FasoliL, SulpassoM, PeaM.A rare case of acute scrotum. Thrombophlebitis from ectasia of the left pampiniforme plexus [in Italian]. Minerva Urol Nefrol1999;51:163–165.
172.
KayesO, PatrickN, SenguptaA.A peculiar case of bilateral, spontaneous thromboses of the pampiniform plexi. Ann R Coll Surg Engl2010;92:W22W23.
173.
WaldbaumRS, BordenD, CohenD, NaidichJ, OkaM.Venous infarction of the testis owing to vena caval thrombosis. J Urol1976;116:259–260.
174.
RoachR, MessingE, StarlingJ.Spontaneous thrombosis of left spermatic vein: report of 2 cases. J Urol1985;134:369–370.
175.
BarringtonFJF.Spontaneous hemorrage into the testicle. Br J Surg1914;2:400–407.
176.
SinclairJ, FerucciP, LovellMA, KoyleMA.Spontaneous testicular hemorrhage in an adolescent. J Urol2003;169:303–304.
177.
GaurS, BhattS, DerchiL, DograV.Spontaneous intratesticular hemorrhage: two case descriptions and brief review of the literature. J Ultrasound Med2011;30:101–104.
178.
YukselMB, AltokM, SayginI, CilogluM.Spontaneous intratesticular hemorrhage in a 15-year-old boy. Urology2011;78:915–917.
179.
HanDP, DmochowskiRR, BlasserMH, AumanJR.Segmental infarction of the testicle: atypical presentation of a testicular mass. J Urol1994;151:159–160.
180.
SharmaSB, GuptaV.Segmental testicular infarction. Indian J Pediatr2005;72:81–82.
GianfrilliD, IsidoriAM, LenziA.Segmental testicular ischaemia: presentation, management and follow-up. Int J Androl2009;32:524–531.
183.
KramolowskyEV, BeauchampRA, MilbyWPIII. Color Doppler ultrasound for the diagnosis of segmental testicular infarction. J Urol1993;150:972–3.
184.
NawrockiJD, CookAJ.Localised infarction of the testis. Br J Urol1992;69:541.
185.
WuVH, DangmanBC, KaufmanRPJr.Sonographic appearance of acute testicular venous infarction in a patient with a hypercoagulable state. J Ultrasound Med1995;14:57–59.
186.
deBeckC, GhasemianR.Acute segmental testicular infarction. Int J Urol2006;13:651–652.
187.
GofritON, RundD, ShapiroA, PappoO, LandauEH, PodeD.Segmental testicular infarction due to sickle cell disease. J Urol1998;160 (3 Pt 1):835–836.
188.
HolmesNM, KaneCJ.Testicular infarction associated with sickle cell disease. J Urol1998;160:130.
189.
LiM, FogartyJ, WhitneyKD, StoneP.Repeated testicular infarction in a patient with sickle cell disease: a possible mechanism for testicular failure. Urology2003;62:551.
190.
BaerHM, GerberWL, KendallAR, LockeJL, PutongPB.Segmental infarct of the testis due to hypersensitivity angiitis. J Urol1989;142:125–127.
191.
EshelG, ZemerD, Bar-YochaiA.Acute orchitis in familial Mediterranean fever. Ann Intern Med1988;109:164–165.
192.
PaikML, MacLennanGT, SeftelAD.Embolic testicular infarction secondary to nonbacterial thrombotic endocarditis in Wegener's granulomatosis. J Urol1999;161:919–920.
193.
AdachiS, TsutaharaK, KinoshitaT, HatanoK, KinouchiT, KobayashiMSegmental testicular infarction due to cholesterol embolism: not the first case, but the first report. Pathol Int2008;58:745–748.
194.
El AtatR, DerouicheA, KourdaN, HammamiA, ChebilM, JilaniS BenSegmental infarction of the testis: an exceptional complication of diabetes microangiopathy. Int J Impot Res2007;19:615–616.
195.
ChinSC, WuCJ, ChenA, HsiaoHS.Segmental hemorrhagic infarction of testis associated with epididymitis. J Clin Ultrasound1998;26:326–328.
BertolottoM, DerchiLE, SidhuPSAcute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol2011;196:834–841.
207.
BilagiP, SriprasadS, ClarkeJL, SellarsME, MuirGH, SidhuPS.Clinical and ultrasound features of segmental testicular infarction: six-year experience from a single centre. Eur Radiol2007;17:2810–2818.
208.
MadaanS, JoniauS, KlockaertsKSegmental testicular infarction. Conservative management is feasible and safe: part 2. Eur Urol2008;53:656–658.
209.
SriprasadS, KooimanGG, MuirGH, SidhuPS.Acute segmental testicular infarction: differentiation from tumour using high frequency colour Doppler ultrasound. Br J Radiol2001;74:965–967.
210.
KendirliT, YukselS, OralMFatal polyarteritis nodosa with gastrointestinal involvement in a child. Pediatr Emerg Care2006;22:810–812.
211.
Hernandez-RodriguezJ, TanCD, KoeningCL, KhasnisA, RodriguezER, HoffmanGS.Testicular vasculitis: findings differentiating isolated disease from systemic disease in 72 patients. Medicine2012;91:75–85.
212.
TonnelierJM, AnsartS, Tilly-GentricA, PennecYL.Juvenile relapsing periarteritis nodosa and streptococcal infection. Joint Bone Spine2000;67:346–348.
213.
KishinoT, FujimotoK, HayashiYA case of polyarteritis nodosa presenting as a mass in scrotum [in Japanese]. Hinyokika Kiyo2001;47:211–213.
214.
Ben-SiraL, LaorT.Severe scrotal pain in boys with Henoch-Schonlein purpura: incidence and sonography. Pediatr Radiol2000;30:125–128.
215.
SozeriB, MirS, ErtanP, KaraOD, SenS.Rapidly progressive glomerulonephritis in a child with Henoch-Schonlein Vasculitis and familial Mediterranean fever. Pediatr Rheumatol Online J2009;7:8.
216.
AkgunC.A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schonlein vasculitis. Bratisl Lek Listy2012;113:382–383.
217.
FernandezMS, DominguezC, SanguesaCThe use of color doppler sonography of the acute scrotum in children [in Spanish]. Cir Pediatr1997;10:25–28.
218.
JequierM, Thurler-ThieleF, LeporiD, GehriM.Radiological quiz of the month. A case of a swollen and painful testis in a child [in French]. Arch Pediatr2005;12:1513–1514.
219.
BarberTD, Al-OmarO, PoulikJ, McLorieGA.Testicular infarction in a 12-year-old boy with Wegener's granulomatosis. Urology2006;67:846.e9–846.e10.
220.
HernandezME, LovrekovicG, SchearsG, HelfaerM, FriedmanD, StaffordPAcute onset of Wegener's granulomatosis and diffuse alveolar hemorrhage treated successfully by extracorporeal membrane oxygenation. Pediatr Crit Care Med2002;3:63–66.
221.
YimHE, YooKH, WonNH, HongYS, LeeJW.Churg-Strauss syndrome in a child with IgA nephropathy. Clin Nephrol2009;71:306–309.
