Presentation
Blunt trauma to pelvis and scrotum. Severe pain in scrotal area, more on right side.
Patient Data
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 tunica albuginea 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.
Case Discussion
Sensitive and specific signs of testicular rupture are:
- heterogeneous echogenicity of the testis
- abnormal contour of the testis
- disrupted tunica albuginea
Loss of vascularity also points towards rupture of the testis.
But note that heterogeneous testicular echotexture may occasionally be present when intratesticular haematoma is the sole abnormality.
Rupture of the tunica albuginea is virtually always found with loss of integrity of the tunica vasculosa, 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 haematomas in the testis.
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