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Pathology · Haemodynamics: infarction
Sample itemA 16-year-old boy has sudden severe scrotal pain. At orchidectomy the testis is enlarged and dark red-black, with the spermatic cord twisted twice on itself. What explains the haemorrhagic appearance of this infarct?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Venous outflow occlusion occurs first while arterial inflow continues, engorging the testis
Red (haemorrhagic) infarcts occur with venous occlusion such as torsion, in loose tissues, in organs with dual circulation like lung and bowel, and after reperfusion. In torsion the thin-walled veins are compressed before the thicker arteries, so blood enters but cannot leave. Pale infarcts occur with arterial occlusion in solid organs with end-artery supply, such as kidney, spleen and heart.
Option by option
A. Embolic occlusion by an infected thrombus with abscess formation
Septic embolism gives a suppurative infarct, which is not a feature of torsion.
B. Abrupt arterial occlusion in a tissue supplied by a single end-artery
End-artery occlusion in solid organs gives a pale, wedge-shaped infarct, as seen in the kidney or spleen.
C. Venous outflow occlusion occurs first while arterial inflow continues, engorging the testis (correct)
Correct. Continued arterial inflow against blocked venous drainage causes haemorrhagic infarction.
D. Gradual atherosclerotic narrowing of the testicular artery
Slow atherosclerotic narrowing produces atrophy or a pale infarct and is rare in a teenager.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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