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Scrotal ultrasound performed related to clinical concern for epididymo-orchitis. Incidental finding noted (see image). Diagnosis/follow up plan? #POCUS #FOAMed #FOAMus #IMPOCUS #MedEd #ultrasound @medpedshosp @ACEP_EUS @HeyDrNik @cianmcdermott @PhilipsPOCUS @thepocusatlas
Patient has testicular microlithiasis. Usually asymptomatic and incidental finding. Relationship with Germ Cell Tumors-?controversial. Ultrasound surveillance had been recommended. Any benefit of ultrasound surveillance over self exam?
Microlithiasis--1 to 3 mm hyperechoic foci without shadowing. Graded as limited (<5 per view), classic (> or = to 5 per view), and diffuse.
EAU/ESUR guidelines on testicular microlithiasis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202617/ Recommend annual u/s surveillance until 55 if has: maldescent, previous germ cell tumor(GST), FH of GST, orchidopexy, testicular atrophy
8-fold risk of GCT in symptomatic patients with microlithiasis with microlithiasis found in 50% of GCT cases. Video of another patient showing GCT in patient with microlithiasis. Pt had family hx of GCT but was not undergoing surveillance prior to acute presentation.
Testicular sweep-TRV
Color Power Doppler Video sweep.
This is a common incidental finding. If you order scrotal u/s in your practice, now how to best arrange follow up for these patients.
