Multiparametric Ultrasound Findings of Testicular Sarcoidosis

OBJECTIVES: To characterize the multiparametric ultrasound (MPUS) features of testicular sarcoidosis, incorporating greyscale, color Doppler ultrasound (CDUS), contrast-enhanced ultrasound (CEUS), and strain elastography (SE), and to assess their collective diagnostic value. METHODS: A retrospective review of our institutional ultrasound database identified patients with testicular lesions and a confirmed diagnosis of sarcoidosis (via histopathology or established clinical criteria) between May 2009 and June 2025. All patients underwent a standardized scrotal MPUS protocol. Lesion characteristics on greyscale, vascularity on CDUS and CEUS, and tissue stiffness on SE were systematically analyzed. RESULTS: Seventeen patients (mean age: 42.1 ± 12.4 years) were included. The MPUS pattern was consistent. On grayscale, all lesions were small, solid (mean largest diameter: 4.3 ± 1.8 mm), hypoechoic, and well-defined. Lesions were multifocal (76.5%) and bilateral (52.9%). CDUS showed absent (47.1%) or low (35.3%) internal vascularity. CEUS demonstrated no enhancement in 62.5% of lesions. SE indicated intermediate (53.3%) or soft (26.7%) tissue elasticity. Follow-up ultrasound demonstrated temporal stability in 76.5% of lesions. CONCLUSION: Testicular sarcoidosis exhibited a suggestive MPUS signature characterized by small, hypoechoic, solid, hypovascular, and stable lesions, often with soft or intermediate elasticity. Recognition of this pattern in the appropriate clinical context can strongly suggest this rare benign diagnosis, guiding conservative management and preventing unnecessary orchidectomy.