A Case of Testicular Malakoplakia With Markedly High Signal Intensity on Fat‐Suppressed T1 ‐Weighted Images

Introduction Testicular malakoplakia is a very rare, chronic granulomatous inflammatory condition that frequently resembles testicular malignancy on imaging studies. Here, we report a case of testicular malakoplakia with characteristic magnetic resonance imaging (MRI) findings and present a brief review of the literature. Case Presentation A man in his 70s presented with left‐sided scrotal pain. Ultrasonography revealed a well‐defined hypoechoic intratesticular mass without internal vascularity, whereas computed tomography revealed enlargement of the left testis with a relative hyperattenuation area. MRI demonstrated low signal intensity on T2‐weighted images, diffusion restriction, and a markedly high signal intensity on fat‐suppressed T1‐weighted images with contrast enhancement. Based on these findings, a malignant testicular tumor was suspected, and radical orchidectomy was conducted. Histopathological examination confirmed testicular malakoplakia with characteristic Michaelis–Gutmann bodies. Conclusion This case highlights the importance of recognizing T1 shortening on fat‐suppressed T1‐weighted MRI as a potential imaging modality for malakoplakia.