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Testicular artery

The testicular artery, also known as the gonadal artery, is a paired branch of the abdominal aorta that supplies blood to the testes and associated structures. It is a slender but vital artery that traverses the retroperitoneum, inguinal canal, and spermatic cord to reach the scrotum. Its course and relations are clinically significant in urology, radiology, and vascular surgery, particularly in cases of varicocele, torsion, trauma, or testicular tumors.

Synonyms

  • Gonadal artery

  • Spermatic artery

  • Artery to the testis

Origin, Course, and Termination

  • Origin:

    • Arises from the anterolateral surface of the abdominal aorta at the level of L2, just inferior to the origin of the renal arteries

  • Course:

    • Descends retroperitoneally, anterior to the psoas major muscle

    • Crosses over the ureter and genitofemoral nerve

    • Passes inferiorly toward the deep inguinal ring, where it enters the inguinal canal

    • Travels through the inguinal canal within the spermatic cord, alongside the pampiniform plexus of veins, ductus deferens, and lymphatics

  • Termination:

    • Reaches the scrotum and divides into multiple branches that supply the testis, epididymis, and coverings of the spermatic cord

Relations

  • Posteriorly: Psoas major muscle

  • Anteriorly: Peritoneum and abdominal viscera

  • Medially: Ureter (artery crosses anterior to ureter)

  • Laterally: Genitofemoral nerve and iliac vessels along its descent

Function

  • Provides arterial blood supply to the testis and epididymis

  • Contributes to thermoregulation of the testis through interaction with the pampiniform plexus

  • Supplies collateral branches to spermatic cord structures

Clinical Significance

  • Varicocele treatment: Important landmark during varicocelectomy or embolization procedures

  • Testicular torsion: Vascular compromise of the testicular artery leads to ischemia and infarction if untreated

  • Oncologic surgery: Ligation of the testicular artery is performed during orchiectomy for testicular tumors

  • Vascular anomalies: Variations may occur with renal or suprarenal arteries; sometimes duplicated

  • Trauma: Artery may be injured in pelvic or scrotal trauma, leading to hemorrhage

MRI Appearance

T1-weighted images:

  • Artery lumen shows flow void (black) due to rapidly moving blood

  • Surrounding fat appears bright, outlining the vessel

T2-weighted images:

  • Lumen also appears as flow void (black)

  • Fat signal appears bright, aiding vessel localization

  • Thrombosed artery may lose flow void and show intermediate signal intensity

STIR (Short Tau Inversion Recovery):

  • Suppresses fat, leaving artery as a flow void (dark line)

  • Inflammation or thrombosis may appear as surrounding bright signal

T1 Fat-Sat Post-Contrast (MR Angiography):

  • Artery enhances brightly with gadolinium contrast, clearly delineating its course

  • Abnormalities (stenosis, aneurysm, or thrombosis) appear as narrowing, dilation, or filling defects

CT Appearance

Non-Contrast CT:

  • Testicular artery is not always well visualized due to small caliber

  • May be seen as a thin tubular soft tissue density alongside the psoas major or in the spermatic cord

  • Surrounding retroperitoneal fat provides contrast for identification

Post-Contrast CT (CT Angiography):

  • Artery enhances brightly, outlining its full course from aorta to scrotum

  • Variations, stenosis, aneurysm, or thrombosis can be assessed

  • Surrounding fat planes help distinguish it from veins and ductus deferens

MRI image

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