What finding on these images is considered a risk factor for testicular tumours?
Testicular microlithiasis, although still controversial, has been reported as up to ~8x increased risk for testicular tumour.
Where is the typical first side of spread of this tumour?
Metastases to the para-aortic lymph nodes at the level of the renal vessels are the typical first site of spread owing to the lymphatic drainage of the testicles relating to embryological testicular descent.
The testicles have normal size and vascularity, showing multiple microcalcifications foci, particularly on the left. Within the upper portions of the left testicle, there is a well-defined 1.1 cm lobulated hypoechogenic nodule that shows increased internal vascularity, but no cystic or calcified components. The epididymides have normal sonographic appearances. No hydrocoele.