PMC3350072_01
Scrotal ultrasound images with color Doppler showing decreased blood flow to the left testicle (a) and right testicle (b). Both images are in the sagittal view.
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fig1
Scrotal ultrasound with color Doppler showed poor blood flow within the left testicle, and bowel or fat was noted superior to the left testicle; see Figure 1(a). A scrotal ultrasound revealed no blood flow, Figure 1(b), and physical examination revealed an edematous right testicle that was very tender to palpation.
Hematoxylin and eosin stains (100x). Testicular specimen showing thrombotic vasculopathy, intravascular papillary endothelial hyperplasia (IPEH), and recanalization.
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fig2
Pathologic evaluation again showed benign testis with acute interstitial hemorrhage and focal atrophy; see Figure 2.
Hematoxylin and eosin stains (600x). Skin biopsy demonstrating fibrin thrombus in the vessel lumen consistent with a clot (black arrow) and fibrin deposition in a postcapillary venule wall with surrounding granulocytic debris, consistent with a leukocytoclastic vasculitis (white arrow).
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fig3
Initially a diagnosis of warfarin-induced skin necrosis was considered, but the skin biopsy of the anterior abdominal wall contained thrombotic vasculopathy with leukocytoclastic vasculitis; see Figure 3.