Blunt trauma to pelvis and scrotum. C/O Severe pain in scrotal area, more on right side.
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Enlarged right testicle with heterogenous echotexture. There are multiple ill defined hypoechoic patchy areas within the right testis. This could represent testicular contusion. There is loss of continues echogenic lining of the tunic albugenia adjacent to hypoechoic areas which is highly suspicious for testicular rupture. On colour doppler there is loss of vascularity in these hypoechoic areas. Soft tissue swelling is also present around the penis. Homogenous echotexture of left testicle.
Heterogenous echotexture within testis, testicular contour abnormality and disruption of tunica albugenia are considered very sensitive and specific for diagnosis of testicular rupture. Absence of vascularity in normal testis may help characterize rupture.
Normal tunica albugenia appears as echogenic lining around the testis. Disruption in this lining is suggestive of testicular disruption or rupture.
Abnormality in contour of testis results from extrusion of testicular parenchyma after disruption of tunica albugenia.
Heterogenous echotexture of testicular parenchyma with contour abnormality is highly sensitive and specific for testicular ruture. Heterogenous echotexture may also be seen in presence of only intratessticular hematomas.
Tunica albugenia rupture is almost always associated with disruption of tunica vasculaosa, which shows loss of vascularity to a portion or entire testis. Absence of vascularity on colour doppler in focal areas may also be secondary to hematomas in the testis.
- Shweta Bhatt, Vikram Dogra. Role of US in testicular and scrotal trauma. Radiographics 2008; 28:1617-1629.