Presentation
Shortness of breath. Left scrotal fullness.
Patient Data
Right PICC line tip at cavoatrial junction, bilateral effusions, multiple lung nodules.
Left testicle: multiple cystic and solid intratesticular masses. Microlithiasis.
Right testicle: not shown, but was normal except for microlithiasis.
Diffuse abdominal and pelvic lymphadenopathy and large liver masses concerning for metastatic disease. Severe narrowing versus occlusion intrahepatic IVC and hepatic vein due to liver lesion. The infrahepatic IVC and left common iliac vein are not well visualized, raising concern for occlusion related to extensive retroperitoneal lymphadenopathy. Mild bilateral hydroureteronephrosis, likely due to extrinsic compression of the ureters by the enlarged retroperitoneal lymph nodes. Moderate complex ascites and diffuse mesenteric edema.
Acute pulmonary embolus in the main pulmonary artery extending into the right main pulmonary artery with additional emboli in the right lobar/upper segmental and left upper segmental arterial branches. No right heart strain or pulmonary infarct. Small bilateral pleural effusions with subjacent atelectasis. Widespread pulmonary metastases. Extensive mediastinal and supraclavicular lymphadenopathy.
Case Discussion
Intratesticular scrotal masses are most likely malignant while extratesticular masses are usually benign. Because the testes arise in the retroperitoneum before descending into the scrotum, the lymphatic drainage of the testes is to the retroperitoneum.
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