Best Practice Case Studies-Ruptured Testicle

Video Transcription

This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University.  20 year old with worsening pain and swelling of his left testicle three days after getting hit in the area with hockey puck.  Concerned for a ruptured testicle. The patient in this case presented with this testicular ultrasound.  Ultrasound is the imaging modality of choice for evaluating testicular rupture. Here on the right side, we have the normal testicle. On the left side, we can see a heterogeneous  testicular parenchyma with areas of hypoecogenicity as seen here, and then here.  Additionally, at the medial aspect of the testicle, we can see a likely disruption of the tunica albigenia,  which is a necessary criteria for diagnosing testicular rupture.  Additionally here, we can see some extra testicular hematoma along the laral side,  characterized by this heterogeneous  echogenicity of fluid collection adjacent to the testicle. This is in a different patient, 18 year old hockey player, with concern for testicular rupture.  Testicular rupture is defined as  tunica albigenia rupture, with associated contour irregularity and  heterogeneous echotexture of the testes. The presence of tunica albigenia rupture is necessary for diagnosis of  testicular rupture. Here on the right testicle, we can see a very heterogeneous testicle with no  vascularity in it. Additionally, we can see this fractured defect at the medial margin of the testicle, and this is the tunica albigenia,  but we could not follow it up in the median aspect of it, consistent with tunica albigenia rupture seen on testicular rupture. Here,  we can see the normal tunica albigenia in a normal left testes.  Additional differential or consideration we look at for testicular trauma includes a testicular fracture, which is typically a linear hypoechoic  vascular area within the testes, which could be with or without tunica albigenia rupture.  Testicular contusion or hematoma, on the other hand, presents as ill-defined areas of heterogeneity or hypoechoic regions without tunica albigenia rupture.  Loss of vascularity on this hypoechoic areas  are also present. The key thing for determining the presence of testicular rupture is the presence of tunica albigenia rupture,  with or without associated chondroirregularity.

Video Summary

A musculoskeletal radiology fellow at Stanford discusses a 20-year-old with testicular trauma following a hockey injury. Testicular ultrasound is used to identify rupture. The injured left testicle exhibits a heterogeneous parenchyma and disrupted tunica albuginea, indicating rupture, alongside extra-testicular hematoma. An 18-year-old patient with similar symptoms shows testicular rupture features like heterogeneous texture and a fractured tunica albuginea. Differentials for testicular trauma include fracture, contusion, or hematoma, distinguished by specific ultrasound patterns. However, key to diagnosing rupture is identifying tunica albuginea disruption, possibly with contour irregularity and heterogeneity in testicular texture.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 55

Topic Uro-Genital

Keywords

2nd Edition, CASE 55

2nd Edition

Uro-Genital

testicular trauma

ultrasound

tunica albuginea

hematoma

radiology