case_images: PMC6604472_01
case_images: Ultrasound of the scrotum demonstrates an enlarged, heterogeneous, hypervascular right testicle and epididymis with focal, relatively hypovascular hypoechoic areas in the testicular parenchyma (white arrow) and an associated small hydrocele (dashed white arrow).
case_images: CRIRA2019-5953618.001.jpg
case_images: PMC6604472_01_CRIRA2019-5953618.001.jpg
case_images: fig1
case_images: The ultrasound study (Figure 1) demonstrated a diffusely enlarged, heterogeneous, hypervascular right testicle with two more discrete hypoechoic intraparenchymal lesions showing minimal internal vascularity and a small associated hydrocoele.
case_images: (a) Axial CT image with contrast at the level of the scrotum demonstrates a right testicular mass (dashed white arrow). (b) Axial CT image with contrast at the level of the inguinal canal demonstrates superior tumour infiltration along the right spermatic cord (white arrow). (c) Axial CT image with contrast at the level of the common iliac vessels demonstrates tumour extension along the right gonadal vein (dashed white arrow). (d) Axial CT image with contrast at the level of the kidneys demonstrating confluent aortocaval soft tissue at the site of gonadal vein insertion into the IVC (white arrow).
case_images: CRIRA2019-5953618.002.jpg
case_images: PMC6604472_01_CRIRA2019-5953618.002.jpg
case_images: fig2
case_images: CT demonstrated an enhancing right-sided testicular mass (Figure 2(a)) with soft tissue extending along the spermatic cord (Figures 2(b)-2(d)), through the inguinal canal and cranially in the retroperitoneum along the gonadal vein to the level of its insertion into the inferior vena cava (Figures 3(a)-3(b)), locally forming a confluent mass.
case_images: (a and b) Coronal and sagittal reformatted CT images of the abdomen and pelvis with contrast which demonstrate cord-like soft tissue extension from the right testicle into the retroperitoneum along the spermatic cord and gonadal vein.
case_images: CRIRA2019-5953618.003.jpg
case_images: PMC6604472_01_CRIRA2019-5953618.003.jpg
case_images: fig3
case_images: CT demonstrated an enhancing right-sided testicular mass (Figure 2(a)) with soft tissue extending along the spermatic cord (Figures 2(b)-2(d)), through the inguinal canal and cranially in the retroperitoneum along the gonadal vein to the level of its insertion into the inferior vena cava (Figures 3(a)-3(b)), locally forming a confluent mass.
case_images: (a) Axial CT image with contrast at the level of the suprahyoid neck revealing an enlarged left palatine tonsil (dashed white arrow). (b) Axial CT image with contrast at the level of the hyoid bone which demonstrates a subcentimetre mucosal soft tissue nodule in the left aryepiglottic fold (white arrow).
case_images: CRIRA2019-5953618.004.jpg
case_images: PMC6604472_01_CRIRA2019-5953618.004.jpg
case_images: fig4
case_images: In addition, an enlarged left faucial tonsil (Figure 4(a)), a mucosal soft tissue nodule (Figure 4(b)) in the left aryepiglottic fold and bilateral adrenal lesions were identified.
case_images: PMC6604472_02
case_images: (a) Axial CT image with contrast at the level of the scrotum demonstrates a large, heterogeneous, right testicular tumour (dashed white arrow). (b) Axial CT image with contrast at the level of the right inguinal canal demonstrates extension of homogeneous soft tissue along the right spermatic cord in the inguinal canal (white arrow). (c) Axial CT image with contrast at the level of the common iliac vessels demonstrates tumour anterior to the right iliac artery and vein (dashed white arrow) along the course of the right gonadal vein. (d) Axial CT image with contrast at the level of the right renal pelvis demonstrates soft tissue in the retroperitoneum along the right gonadal vein to the level of its insertion into the inferior vena cava (white arrow).
case_images: CRIRA2019-5953618.005.jpg
case_images: PMC6604472_02_CRIRA2019-5953618.005.jpg
case_images: fig5
case_images: The study demonstrated a large right-sided scrotal mass (Figures 5(a)-5(d)) with soft tissue extending through the inguinal canal and along the right gonadal vein throughout its course to the insertion point into the inferior vena cava (Figures 6(a)-6(b)), as well as a few bilateral lung nodules measuring up to 14mm, considered to be metastatic (Figure 7).
case_images: (a and b) Sagittal and coronal reformatted CT images of the abdomen and pelvis with contrast demonstrating cranial extension of the tumour from the scrotum, along the spermatic cord in the inguinal canal and into the retroperitoneum along the right gonadal vein, to the level of its insertion into the inferior vena cava. Incidental note made of a left extrarenal pelvis.
case_images: CRIRA2019-5953618.006.jpg
case_images: PMC6604472_02_CRIRA2019-5953618.006.jpg
case_images: fig6
case_images: The study demonstrated a large right-sided scrotal mass (Figures 5(a)-5(d)) with soft tissue extending through the inguinal canal and along the right gonadal vein throughout its course to the insertion point into the inferior vena cava (Figures 6(a)-6(b)), as well as a few bilateral lung nodules measuring up to 14mm, considered to be metastatic (Figure 7).
case_images: Axial CT image of the chest with lung windows revealing a pulmonary nodule in the posterior basal segment of the left lower lobe (white arrow).
case_images: CRIRA2019-5953618.007.jpg
case_images: PMC6604472_02_CRIRA2019-5953618.007.jpg
case_images: fig7
case_images: The study demonstrated a large right-sided scrotal mass (Figures 5(a)-5(d)) with soft tissue extending through the inguinal canal and along the right gonadal vein throughout its course to the insertion point into the inferior vena cava (Figures 6(a)-6(b)), as well as a few bilateral lung nodules measuring up to 14mm, considered to be metastatic (Figure 7).
case_images: (a) Ultrasound of the scrotum demonstrates an enlarged diffusely heterogeneous right testicle and epididymis with areas of increased vascularity. (b) Ultrasound of the right spermatic cord at the level of the right inguinal canal. Image demonstrates a tubular predominantly hypoechoic mass with internal vascularity (white arrow).
case_images: CRIRA2019-5953618.008.jpg
case_images: PMC6604472_02_CRIRA2019-5953618.008.jpg
case_images: fig8
case_images: A subsequent ultrasound (Figure 8) was performed to further assess the scrotal lesion.