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Tubular Ectasia of Rete Testis

Tubular Ectasia of Rete Testis

• Dilated rete testis
• Cystic transformation of rete testis

Best diagnostic clue
○ Variably sized network of dilated tubules near mediastinum testis with no flow on color Doppler

○ Posterior near mediastinum testis
○ Frequently bilateral

○ Can replace large portion of normal parenchyma
○ Variably sized cystic spaces

○ Branching tubules converging at mediastinum testis
○ Characteristic appearance and location make it possible to distinguish this benign condition from malignancy

Ultrasonographic Findings
• Grayscale ultrasound
○ Longitudinal plane shows branching tubular structures along mediastinum
○ Dilated tubules create lace-like or "fishnet" appearance
○ Adjacent parenchyma is normal . it Differentiates it from cystic malignant masses, which have abnormal rind of parenchyma
○ Associated ipsilateral spermatoceles are common. May also see intratesticular cysts

Color Doppler
○ Tubules are avascular and fluid filled, hence no color flow
○ Normal flow in adjacent testicular parenchyma

MR Findings
• MR performed for confirmation if cystic malignant neoplasm cannot be ruled out
• T1 and proton density-weighted Images: Hypointense to testis
• T2WI: Iso- to hyperintense to testis → nearly invisible
○ Malignant testicular neoplasms → solid portions hypointense on T2WI; have dark fibrous capsule

• Best imaging tool
○ High-resolution US (≥ 7.5 MHz) is imaging modality of

• Protocol advice
○ Longitudinal plane shows morphology of tubules far better than transverse plane. It  Appears more mass-like and has greater likelihood of causing confusion when viewed in transverse plane
○ Always use color Doppler to look for areas of abnormal parenchymal flow

• Etiology
○ Partial or complete efferent ductule obstruction → ectasia → eventually cystic transformation
○ May be associated with epididymal obstruction due to inflammation or trauma

• Associated abnormalities
○ Spermatocele
○ Epididymal cyst
○ Intratesticular cyst

○ Generally nonpalpable and asymptomatic
○ May be found when doing ultrasound for related issue, such as epididymal cyst or spermatocele

○ Middle-aged to elderly men most commonly affected

• Important to distinguish tubular ectasia from malignancy to prevent unnecessary orchiectomy

Imaging Gallery

 grayscale ultrasound of the testes demonstrates bilateral tubular ectasia of the rete testis, which is slightly asymmetric, right greater than left 
color Doppler ultrasound of the right testicle demonstrates avascular cystic areas within the testis  with a cystic area within the epididymal head . These findings are consistent with tubular ectasia of the rete testis with associated spermatocele.

 grayscale ultrasound of the left testis demonstrates cystic areas within the mediastinum testis, consistent with tubular ectasia of the rete testis.

grayscale ultrasound of the epididymal head demonstrates large spermatoceles with partially visualized tubular ectasia .

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