Testicular pain in a young male

24 years young male complains of severe pain in right testis since two days.
USG shows hypoechoic lesion near lower pole. MRI was done.

what do you think is the diagnosis..?

Let us see the findings first.

arrow points to a triangular hypointensity.

arrows point to a triangular hypointensity.

an area of facilitated diffusion seen in lower pole of right testis.

T1 contrast and in particular subtraction image shows area of lack of enhancement surrounded by well enhancing rim.

These findings with history of pain are consistent with segmental testicular infarct.

what are radiological findings of segmental testicular infarction.

It is characterised by presence of a triangular shaped avascular intrataesticular lesion on sonography or MRI and enhancement of surrounding borders on MRI.

how do you differentiate it from testicular tumor.

triangular shape , lack of vascularity , clinical setting of severe pain are differenital features of segmental infarct. follow up should be advised.

what is the follow up in this patient.

this patient is under observation and is getting better.

reference
Gabriel Fernandez et al. radiologic findings of segmental testicular infarction.AJR May 2005

MR Urography of Sober Ureterostomy

Follow up MR urography in a patient who had undergone bilateral Sober ureterostomy for posterior urethral valve.

This procedure involves the division of the ureter with reanastomosis of the distal limb to the side of the proximal limb (arrows) . The proximal limb extends to the cutaneous surfaces covered by ureterostomy bags.

Right inguinal hernia

Coracoclavicular joint

This patient presented with pain  in the region of the lateral aspect of the left clavicle.

Congenital costoclavicular joint is rare and is usually a bilateral anatomic variant and asymptomatic.

In the absence of other pathology in cases of shoulder pain these joints may produce symptoms of supracoracoid impingement ( pain on flexion and neutral rotation).

Right Diaphragmatic Hernia

A case of a 14 year old boy who had a history of previous congenital hernia repair.


Presented with recurrent diaphragmatic hernia.


Note the herniation of the liver, hepatic flexure and loops of small bowel ( grey solid arrow) into the right lower lung-thus collapsing the right lower lobe .


On the sagittal images note the stretched mesentery and mesenteric vessels across the anterior surface of the liver (yellow pentagon).


Diagnosis: Recurrent diaphragmatic hernia

Radial Meniscal tear

22 year old man with a history of injury 2 months ago.


There is a high signal defect in the inner margin of the posterior horn of the medial meniscus on the coronal PD and PDFS sequences ( yellow pentagon).


On the sagittal images the defect is seen as a "truncated triangle" ( grey solid arrow).


Appearances are indicative of a radial tear 

Ovarian Torsion

(a) Coronal T2 

                                                             

                                                               (b) Sagittal T2 

                                                               (c) Axial T2 - fat sat 

                                                                   (d) Axial T1 

                                                             
                                     (e) Coronal T2 




18 year old girl presented with left sided pelvic pain.


Coronal & Axial T2 images demonstrate an enlarged engorged congested left ovary (grey arrow) that demonstrates a hyperintense central stroma with peripheral follicles 


There is a large thick-walled right sided exophytic ovarian cyst (yellow pentagon) seen on the (c)T2 fat sat images.


There is associated free fluid in the pelvis (curved arrow).

The T1 images (d) also shows a mildly hyperintense stroma indicating congestion.

On the magnified coronal T2 (e) note the twisted fallopian tube  (notched arrow).


In this case the uterus was noted to be pulled towards the side of the torted ovary.


Conclusion: Enlarged congested left ovary with coexistent cyst and twisted pedicle is pathognomonic of ovarian torsion.