common causes of testicular calcification

1. Testicular Calcifications
Hisham AlKhatib, M.D.
Consultant Radiologist

2. •‫اله‬ ‫وعلى‬ ‫هللا‬ ‫رسول‬ ‫على‬ ‫والسالم‬ ‫والصالة‬ ‫هلل‬ ‫الحمد‬
‫اجمعين‬ ‫م‬ّ‫ل‬‫وس‬ ‫وصحبه‬
•، ‫علما‬ ‫وزدني‬ ‫ينفعني‬ ‫بما‬ ‫وعلمني‬ ‫علمتني‬ ‫بما‬ ‫انفعني‬ ‫اللهم‬
‫الحكيم‬ ‫العليم‬ ‫انك‬
• Praise be to Allah and prayers be upon the
Messenger of Allah and his family and
companions.
• Oh God, give me the benefit of what you
have taught me and teach me what benefits
me.

3. ESSENTIAL INFORMATION

4. • Correlation between clinical and sonographic
features essential
– Incidental finding: Testicular microlithiasis, scrotal
pearl
– History of pain: Abscess, chronic infections,
tumors
– Mass with intrinsic calcification: Testicular tumors,
epidermoid cyst
– Associated with trauma: Testicular hematoma,
hematocele

5. DIFFERENTIAL DIAGNOSIS

6. • Common
• Less common
• Rare but important

7. Common Causes

8. • • Testicular Microlithiasis
• • Nonseminomatous Germ Cell Tumor
• • Sertoli Cell Tumor

9. Helpful Clues for Common
Diagnoses

10. Testicular Microlithiasis
• Multiple small (2-3 mm), discrete,
nonshadowing, echogenic intratesticular foci
• Unilateral or bilateral involvement
• Concurrent germ cell tumor in up to 40%

15. Nonseminomatous Germ Cell
Tumor
• Complex solid-cystic testicular mass
• Heterogeneous echogenic foci due to
calcification ± fibrosis, along with
retroperitoneal lymphadenopathy can be seen
with burnt out testicular tumor
• Calcifications more common in tumors that
contain teratomatous components

17. Sertoli Cell Tumor
• Small, hypoechoic, solid-cystic mass
• Punctate calcification may be present
• Occasionally, tumoral calcification may form
large calcified mass, known as large calcifying
Sertoli cell tumor

21. Less Common Causes

22. • • Scrotal Trauma
• • Scrotal Pearl
• • Epidermoid Cyst
• • Scrotal Abscess or Epididymoorchitis
• • Calcified Tunica Albuginea Cyst

23. Helpful Clues for Less Common
Diagnoses

24. Scrotal Trauma
• Chronic hematocele
– Complex echogenic fluid
– If chronic, appears as heterogeneous echogenic
mass, ± calcification
– No intrinsic vascularity on Doppler

26. Scrotal Pearl
• Calcification of detached testicular epididymal
appendages due to previous inflammation or
torsion of appendages
• Solitary, discrete, echogenic focus in tunica
vaginalis

29. Epidermoid Cyst
• Lamellated appearance on ultrasound
• May have peripheral calcified rim

32. Scrotal Abscess or Epididymoorchitis
• Tuberculous infections may produce
intrascrotal calcifications, scrotal sinuses
• Granulomas appear as small echogenic foci, ±
calcification

34. Calcified Tunica Albuginea Cyst
• Typically located at anterosuperior aspect of
testis
• Within tunica albuginea; may cause mass
effect on testicular parenchyma if large
• Avascular

36. THANK YOU