Testicular rupture in a young patient: diagnostic value of contrast-enhanced ultrasonography

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Abstract

Testicular rupture after a blunt scrotal trauma is characterized by tearing of the tunica albuginea that result in the extrusion of the seminiferous tubules.

Imaging, particularly ultrasonography, plays a crucial role in the assessment of scrotal trauma and directs patient management toward conservative or surgical treatment. Conventional B-mode and color Doppler ultrasonography are the main imaging techniques in the evaluation of the testicle in trauma but may underestimate the extent of injury. The most important information for the surgeon is the integrity or interruption of the tunica albuginea and the extent of vital testicular tissue. The latter is often difficult to assess with conventional ultrasonography because the injured testicle is often hypovascular even in vital regions due to testicular edema that compromises vascular flow. The selective use of advanced techniques such as contrast-enhanced ultrasonography is important in identifying testicular viability when color Doppler ultrasonography is equivocal.

This case report describes the evaluation and management of a blunt testicular trauma in a 15-year-old football player.

About the authors

Laura Eusebi

Radiology Unit, “Carlo Urbani” Hospital

Email: lauraeu@virgilio.it
ORCID iD: 0000-0002-4172-5126
Italy, Jesi

Maria T. Paparella

Department of Clinical and Experimental Medicine, Foggia University School of Medicine

Email: mt.paparella@gmail.com
ORCID iD: 0000-0003-2573-9509
Italy, Foggia

Andrea Marconi

Department of Urology, “Carlo Urbani” Hospital

Email: andreamarconi3@virgilio.it
Italy, Jesi

Giuseppe Guglielmi

Department of Clinical and Experimental Medicine, Foggia University School of Medicine; Radiology Unit, Barletta University Campus UNIFG, “Dimiccoli” Hospital

Author for correspondence.
Email: giuseppe.guglielmi@unifg.it
ORCID iD: 0000-0002-4325-8330

Medical Doctor, Full Professor of Radiology, Department of Clinical and Experimental Medicine.

Italy, Foggia; Foggia

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2. Figure 1. B-mode ultrasonography images. (a) Interruption of the tunica albuginea with the protrusion of echogenic material (arrow) that represents an index of breaking. (b) Hematocele of moderate size (arrow) and a heterogeneous appearance of testicular parenchyma, attributable to an intratesticular contusion.

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3. Figure 2. Color Doppler ultrasonography image showing an irregular testicular morphology with an avascular area at the breaking point (arrow).

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4. Figure 3. Contrast-enhanced ultrasonography image determines the extent of vital parenchyma, helping in the preoperative decision-making process, and allows the recovery of vital testicular tissue, avoiding the need for orchidectomy.

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5. Figure 4. Intraoperative images. (a) Confirmed rupture of the tunica albuginea. (b) Primary albuginea closure.

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Copyright (c) 2022 Eusebi L., Paparella M.T., Marconi A., Guglielmi G.

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