Season 10 Case 14

History: Trauma

Season 10 Case 14

History: Trauma

Can you name the body part and the diagnosis?


Answer:

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Testicular Fracture

As the name implies, this is a traumatic tear to the parenchyma of the testicle. This is often associated with rupture of the tunica albuginea (as show above).

Radiology

Ultrasound is the key diagnostic modality in examination of the scrotum and testicles.

  • Hypoechoic line or parenchyma within the testicle (similar to an organ laceration on CT)
  • Contour irregularity of the testicle
  • Closely examine vascularity of all portions of the testicle, looking for areas of devascularization (remember the whole testicle doesn't have to be devascularized)
  • Look for an associated complex hydrocoele (ie hematocoele) and other injuries - don't forget to perform a careful examination of the contralateral testicle also!

Treatment/Progrosis

  • Prompt surgical consultation and imaging to assess for viability.
  • Treatment can range from debridement to resection depending on degree of injury and amount of viable (vascular) tissue remaining

Our Patient

These images show marked contour abnormality of the right testicle consistent with tunica albuginea rupture and fracture of the parenchyma with extrusion of the parenchyma beyond the capsule (ie area so graciously surrounded by areas by the technologist). This same area is very heterogeneous in echotexture with essentially absent vascular flow on both color Doppler (left images) and Power with M-mode (bottom right).

Above left images better demonstrates the extruded testicular parenchyma beyond the tunica, almost surrounding the epididymus (calipers).

Above right images shows the hematocoele (ie clot/complex fluid) around the testicle.

While rare, these do certainly occur, and prompt diagnosis and treatment is key to minimizing morbity.