Presentation
Got hit in left scrotum by football
Patient Data
Hypoechoic left testis with no internal flow. Head of epididymis markedly enlarged and inhomogeneous. Small amount of septated fluid adjacent to it, most probably aging blood. Entire epididymis with no internal flow. Absent flow in testicular cord. Ipsilateral scrotum thickened and hyperemic.
Right testis appeared normal.
Necrotic left testis prior to excision.
Photo courtesy of Dr Mohammad Majdoub.
Case Discussion
Patient took a soccer ball to the left scrotum. Pain was "tolerable" for several days. Pain increased on the day prior to presentation. On manual examination, there was erythema, swelling, thickening, and induration of left scrotum. Left testis could not be separated from its epididymis.
Ultrasonic examination with Doppler interrogation demonstrated a hypoechoic left testis with no internal flow. Head of epididymis was thickened and inhomogeneous and entire epididymis showed no internal flow. Right testis appeared completely normal.
At surgery, left testis was completely necrotic. Cord had torsed 540 degrees. Testis was promptly excised and contralateral orchiopexy was performed. Of note, what had appeared at ultrasound as a thickened head of epididymis was actually part of the torsed testicular cord, or perhaps a conglomeration of both epidydimal head and cord.