PMC7873883_01
Thoraco-abdominal contrast-enhanced computed tomography (CT) scan showing hilar and mediastinal lymphadenopathies (A), enlarged retroperitoneal lymph nodes, and multiple hepatic and splenic hypodense lesions (B). Positron emission tomography-computed tomography (PET/CT) detecting an increased focal 18F-Fludeoxyglucose (18F-FDG) uptake in the mediastinal and abdominal lesions (C) and in the left testis (D).
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F1
CT scan for a correct lesions characterization and staging. CT scan demonstrated bilateral hilar lymphadenopathies in the chest, pulmonary perilymphatic micronodules, enlarged retroperitoneal lymph nodes, and confirmed the hepatic and splenic lesions (Figures 1A,B). The first diagnostic hypothesis was the lymphoma and a 18F-Fludeoxyglucose (18F-FDG) PET/CT was performed, showing increased 18F-FDG uptake (standardized uptake value (SUV) max=17 at the chest hilar lymphadenopathies level) in all the lesions revealed on CT (Figure 1C). Moreover, a focal uptake was detected in left testis (Figure 1D).
B-mode ultrasonography showing one hypoechoic lesion in the left testis with ill-defined margins (A) and some Color-Doppler flow (B). Contrast-enhanced ultrasonography showing the hypovascular appearance of the lesions as compared to the surrounding testicular tissue (C).
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F2
The US demonstrated, using the B-mode evaluation, a hypoechoic lesion of 20 mm with ill-defined margins in the left testis (Figure 2A) corresponding to the lesion identified on PET-CT; moreover, differently from the latter technique, the US identified a smaller and well-shaped hypoechoic lesion also in the right testis (6 mm). The Color Doppler demonstrated the presence of vascular flow within the lesions (Figure 2B). Italy) followed by 10 mL of 0.9% saline solution. Both the testicular lesions demonstrated the same pattern on CEUS. In particular, during the arterial phase, the masses showed a hypovascular appearance as compared to the surrounding testicular tissue (Figure 2C), maintaining the hypo-enhancement in the late phase.