Microlitíase testicular, Testicular microlithiasis, Microlitiasis testicular

<jats:p>Introduction: Testicular microlithiasis is an ultrasonographic finding characterized by multiple punctate hyperechoic intratesticular foci, usually without posterior acoustic shadowing. Although frequently incidental and asymptomatic, it may be observed in association with infertility, abnormalities of testicular development, genetic syndromes, and, in specific contexts, germ cell neoplasms. Objectives: To evaluate the ultrasonographic patterns of testicular microlithiasis, both as an isolated finding and in different clinical contexts, as well as to discuss recommendations for ultrasonographic follow-up. Methods: A narrative literature review with an iconographic focus was conducted through a search of the PubMed database, considering articles published between 2015 and 2025 addressing testicular microlithiasis from an ultrasonographic perspective. Studies containing representative B-mode and/or Doppler images related to classification, clinical presentations, associated conditions, and follow-up recommendations were included. Results and discussion: Testicular microlithiasis can be classified as limited, classic, or diffuse, according to the number and distribution of microliths. Ultrasonography allows characterization of the pattern of involvement, assessment of laterality, testicular volume, atrophy, echotexture, focal abnormalities, and Doppler vascularization. Isolated microlithiasis, in the absence of a focal mass, atrophy, or additional risk factors, generally does not require serial ultrasonographic follow-up. Conversely, when associated with risk factors or a focal lesion, it should prompt specialized clinical evaluation and individualized follow-up. Conclusion: Testicular microlithiasis should be interpreted within its clinical and ultrasonographic context. For the ultrasonographer, the central objective is to recognize its imaging patterns, investigate associated findings, and guide management proportionally to the patient's risk, avoiding both the underdiagnosis of relevant lesions and excessive follow-up of isolated incidental findings.</jats:p>