A single case of segmental testicular infarction resolved with heparin — no surgery, no orchiectomy
Journal: Medicine | Published: 2026-02-27 | Type: Case Report | PMID:41760026Authors: Yang Tong, Chen Wenxin, Abdurexiti Alimujiang, Gan Zhilu, Zhang Ning (Department of Urology, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China)
Funding/COI: No funding disclosed. Authors declare no conflicts of interest.
Summary
A single adult male presented with 14 hours of acute right scrotal pain and was diagnosed with segmental testicular infarction (STI) via color Doppler ultrasound. He was managed conservatively with subcutaneous low-molecular-weight heparin and anti-inflammatory medication, without surgery. Pain resolved within 4 days; repeat ultrasound at 2 weeks showed the right testicle had returned to normal appearance.
Claims
STI is rare and frequently misdiagnosed, commonly confused with testicular torsion or malignancy
Color Doppler ultrasound can detect reduced or absent intratesticular blood flow and is described as an effective initial screening tool
MRI and contrast-enhanced ultrasound are presented as more definitive diagnostic tools
Known etiologies include vasculitis, atherosclerosis, trauma, epididymitis/orchitis, anatomical abnormalities, and hematologic disorders (sickle cell anemia, polycythemia vera, protein C deficiency)
Conservative management with heparin resolved the infarction in this patient without orchiectomy
Study Quality
This is a single case report — the lowest tier of clinical evidence. There is no control group, no comparator arm, no population-level data, and no way to determine whether the outcome (resolution) resulted from treatment or from natural history. The paper provides no imaging figures, laboratory values, or objective outcome measurements beyond the clinical narrative.
The discussion section leans heavily on secondary literature to contextualize STI etiology and differential diagnosis, but the case itself contributes nothing quantifiable to the evidence base.
Red Flags
N=1. One patient. No generalizability.
No imaging reproduced in the abstract; the full text discussion does not include the patient's actual ultrasound findings in numeric or descriptive detail
Natural history of STI is poorly characterized — it is unclear whether this patient would have recovered without heparin
No follow-up beyond 2 weeks; long-term testicular function (semen analysis, hormone levels) not assessed
Discussion section makes broad clinical recommendations ("individualized treatment to preserve testicular function") that are not supported by the single case presented
Hospital affiliation is a regional tertiary center in Xinjiang — no information on case volume or STI experience
Strengths
Documents a genuinely rare diagnosis; case reports for uncommon conditions contribute to pattern recognition in the literature
Conservative management approach (avoiding orchiectomy) is notable and consistent with recent trend toward organ preservation in STI
Differential diagnosis section is reasonably thorough for distinguishing STI from torsion, epididymo-orchitis, and testicular tumors
Verdict
One patient. Two weeks of follow-up. No imaging data shown. This paper adds a data point to the sparse STI literature but proves nothing about treatment efficacy. Its clinical value is limited to reinforcing awareness that STI exists and can mimic torsion — a useful reminder for emergency urology, not evidence for any management protocol. File under "rare diagnosis awareness," not "evidence-based practice."