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  • Dr is confused and now I'm getting nervous

    Good evening

    Newcomer to the forums here. 29 years old, active and healthy. So before I get into the visit with my urologist, let me give you some back story here...

    I was at work this past sunday night 10/22. Around midnight I had gotten up to walk around a little and stretch my legs. I felt a tickle in my throat so I coughed to get rid of it and almost instantly, it felt like someone had grabbed my right testicle and was squeezing as hard as they could. I was able to stagger my way into dispatch and blurt out "I need an ambulance" before crumpling into my chair. The pain was so intense I couldn't breathe, I couldn't move...it was the most intense pain I've ever experienced in my life, and thats going up against getting hit by a truck coming off the highway and eating a reaper pepper hahaha...so anyways...our medics run into dispatch and get me on the stretcher and give me 100 of fentanyl before taking me to the er. on arrival, i was given 5 of percocet and sent for ultrasound. The ultrasound revealed a 1.9x1.7x1.6 cm hypoechoic heterogeneous mass on my right testicle and a 0.8x0.6x0.5 cm mass on the left testicle. The mass on the left showed no blood flow within with doppler and the mass on the right showed decreased/minimal blood flow. My urine sample was clean, there was no sign of torsion or epididymitis, no orchitis, and no hernia.

    My urologist has me taking ibuprofen or percocet when i need to for the pain, but other than that he wants me to wait 3 more weeks before i do another ultrasound. one of my marker blood tests came back negative (the person who called didnt specify which marker was negative). So to wrap it up, my doc said he doesn't have a clue with what this could be. It's clearly a hypoechoic mass on US but be thinks it might look like an infarct. Again, though, he is confused on how I could have a bilateral testicular infarct when theres nothing to indicate to him what would have caused that. The mass on the left testicle appeared a a nearly solid black oval on the grayscale, while the mass on the right side was much bigger, almost looking like a hurricane on radar.

    My dad believes that perhaps I could have had a tumor growing in the right testicle which started off with a good supply of blood but as it grew in size, it started to pinch of said blood supply which could have lead to some sort of infarct?

    Prior to this occurrence, I have not had many other issues with my testicles. I had a bout of epididymitis appx 3 years ago from a weight lifting oops which resolved. No STI's and while I do have family histories of cancer, none have been testicular cancer. My right testicle had been a little tender and sore 2 days prior to the squeezing pain on sunday. Ever since then, my right testicle has been a little sensitive to touch and it feels like it weighs more or is just slightly swollen. When I try to feel for a mass, I can't really feel much but to be honest, I never really gave myself any self exams (boo on me) so I don't know what I'm comparing to. Now I have to modify my gait a little when I walk because my testicle hitting my leg doesn't exactly hurt, but it definitely feels uncomfortable. Most of the time it doesn't hurt, but every few minutes I might get a little cramp to remind me that its still there.

    Has anyone ever gone through something like this or know anyone who did? And how did it work out for them? I'm okay with if it turns out to be TC. My fiancee is wonderful and she is my rock and will support me no matter the outcome, but what I'm not okay with is waiting for what feels like forever when I KNOW something isn't right..

    EDIT: Just to add that another one of my symptoms I have been experiencing after this episode of acute pain has been this heavy feeling in my pelvic area. You know that feeling you get there when you have to hold in your pee for a really really long time and you feel a lot of that pressure? I have a lot of that, even right after I've gone pee. I don't know if this is a symptom related at all to this or if it might be because I'm on percocet and I know that can cause constipation..but I've at least had one BM today (sorry for tmi but theres no modesty when it comes to this lol)
    Last edited by dped88; 11-04-17, 10:59 AM.

  • #2
    I had pain like bebig kicked in the balls (which caused me to go to ER) and “heavy” feeling in my testicle. Doctors also told me that I have an infection and gave me antibiotics which cleared it and pain went away. Ultrasound showed a solid mass with increased blood flow which my urologist interpreted as “most likely cancer”. Pathology showed that he was wrong about it and it was an infraction (still pissed off at him about making a mistake),
    Right now he (and others) seem to think that it could have been caused by auto immune disease, so I am going to do some blood tests.

    Not saying that it is what you have, but my symptoms were similar.

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    • #3
      Hi vpirh and thanks for your input

      Did you have any symptoms like fever accompanying this or any injuries? I'm certainly happy for you that it wasnt TC but I hope it isnt autoimmune related either..that doesn't sound very fun. Did they determine what it was exactly that caused the infarction? Was it a clot or a collapsed blood vessel or something like that?

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      • #4
        No fever or injuries. Doctor did not know what caused the infraction. I guess that is what I am trying to find out with these tests and referral to rumathologist

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        • #5
          Good luck and keep us up to date! What was their treatment plan for an infarct?

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          • #6
            They removed the ball because they thought it was cancer. They learned that it was an infraction only after pathology.

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            • #7
              That's unfortunate to hear and I'm sorry for that. Did they explain what treatment could have been had they known in the first place it was an infarction? I'm wondering if after an infarct if there's dead tissue that would need to be removed anyway or if its something that would heal up on its own with medication? I'm not too too upset with the thought of having an orchiectomy is needed as I already have two kids if it's my best option, but my doc hasn't really given me a whole lot of confidence in him so far :/

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              • #8
                Yes. He mentioned that normally they would just leave it alone. And that the infraction testicle would have probably shrunk over time.

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                • #9
                  As long as your tumor markers are negative and you are comfortable with the decision to wait and re-do the ultrasound then I personally wouldn't be too worried with the wait if it is testicular cancer as it would be highly unlikely to affect your outcomes. I would want to make sure that the tumor markers are negative though. It is my understanding that determining an infarct from a tumor can be a bit difficult with ultrasound. Having testicular cancer bilaterally at the same time is rare, occurring in less than 1% of guys to my knowledge.

                  I suppose that you could get a second opinion but I think this more relates to the radiologists interpretation of the ultrasound than necessarily the urologists judgement (unless of course the urologist reviewed the ultrasound too).

                  Mike
                  Oct. 2005 felt lump but waited over 7 months.
                  06.15.06 "You have Cancer"
                  06.26.06 Left I/O
                  06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                  06.30.06 It's Official - Stage I Seminoma
                  Surveillance...
                  Founded the Testicular Cancer Society
                  6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                  Comment


                  • #10
                    dped,
                    Has your doc *ever* treated a case of TC? Don't be surprised if the answer is no. Most docs see only one or two during their entire career.

                    Here's wehat the Testicular Cancer Resource Center dictionary ( http://tcrc.acor.org/dictionary.html#GlossH ) has to say about :hypoechoic":
                    Hypoechoic - A term used to describe a part of an ultrasound image where the echoes are not as bright as normal or are less bright than the surrounding structures. Hypoechoic structures in the testicle usually mean there is a solid mass inside the testicle, and that mass is very likely to be cancerous and should be removed.
                    I'd want to know why your doc thinks it's not TC, Is he seeing something unusual for a hypoechoic mass? My guess is he's afraid to make a TC diagnosis.
                    Dave
                    Jan, 1975: Right I/O, followed by RPLND
                    Dec, 2009: Left I/O, followed by 3xBEP

                    Comment


                    • #11
                      The urologist sat down with me and we reviewed the images together. He pointed out the different areas and explained what was what and what it meant and why he was confused. He was expecting increased blood flow to the mass if it was TC, not decreased. I would sure hope he has treated a case or two of TC as his business card reads Urology Medical Director..

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                      • #12
                        Originally posted by dped88 View Post
                        I would sure hope he has treated a case or two of TC as his business card reads Urology Medical Director..
                        One would be surprised how many testis cancer patients physicians see. Out of 1500 centers in the National Cancer Database less than 20 see 20 or more new testis cancer patients per year. A great article about quantity and quality of care is at: Practice Makes Perfect: The Rest of the Story in Testicular Cancer as a Model Curable Neoplasm

                        Mike
                        Oct. 2005 felt lump but waited over 7 months.
                        06.15.06 "You have Cancer"
                        06.26.06 Left I/O
                        06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                        06.30.06 It's Official - Stage I Seminoma
                        Surveillance...
                        Founded the Testicular Cancer Society
                        6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                        Comment


                        • #13
                          I got a call from the doctors today and both my marker tests are negative. Ill have to give that article a read once I'm back home on my computer. Although perhaps in light of the fact that many doctors usually do not see this, maybe seeking a second opinion wouldn't be such a bad idea? If the markers are negative, what else could it be? At this point with a 2 cm mass, is surgery a foreseeable thing in my future whether it's benign or malignant?
                          Last edited by dped88; 10-26-17, 01:11 PM.

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                          • #14
                            If it is an infarction I am not sure that they would necessarily do surgery but I am not all that versed. Getting a second opinion is never a bad idea. There is this article for radiologists and under infarction they do mention re-doing the ultrasound and that they are usually hypoechoic and without blood flow. http://pubs.rsna.org/doi/full/10.1148/rg.352140097

                            I think they key is certainly going to be following up as indicated by the first doctor or getting a second opinion. If the markers were elevated then that would indicate the need for immediate removal. Although one can have testis cancer with negative markers so the negative markers are not all that helpful but elevated markers would have been more alarming.

                            Mike
                            Oct. 2005 felt lump but waited over 7 months.
                            06.15.06 "You have Cancer"
                            06.26.06 Left I/O
                            06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                            06.30.06 It's Official - Stage I Seminoma
                            Surveillance...
                            Founded the Testicular Cancer Society
                            6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                            Comment


                            • #15
                              This chronic ache is seriously uncomfortable. It feels like someone is swueezing it just a little too hard, enough to kind of take your breathe away quickly. Good lord

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