Diagnostic ultrasound ( PDFDrive )

1898 PART V Pediatric Sonography
H
T
A
B
FIG. 54.42 Testicular Rupture in Patient With Scrotal Pain After Groin Kick. (A) Longitudinal view of the inferior aspect of the left testis
shows disruption of the tunica albuginea (straight arrows) with extrusion of seminiferous tubules (curved arrows). Associated hematocele (H) is
present. T, Testis. (B) Color Doppler image of the left testis reveals heterogeneity, representing contusion and hemorrhage within the testicular
parenchyma. Intratesticular low excludes infarction.
Testis
e t h
A
B
C
FIG. 54.43 Acute Idiopathic Scrotal Edema With Normal Testes in 4-Year-Old Boy With Sudden, Painless, Scrotal Swelling. Transverse
(A) sonogram of the scrotum and sagittal ([B] and [C]) images of the left hemiscrotum using a stepoff pad reveal marked scrotal swelling, normal
right testis (t), and epididymis (e) with an adjacent hydrocele (h). The left testis and epididymis (not shown) were also normal.
albuginea, extrusion of seminiferous tubules, and nonvisualization
of the testis. he presence of low on color Doppler imaging in
the traumatized testis is helpful in excluding testicular ischemia.
Conversely, with testicular fracture, there is discontinuity of the
normal testicular parenchyma, but the tunica albuginea remains
intact. On ultrasound, a fracture is seen as a hypoechoic line
within a normally shaped testicle. 117,129 Testicular hematomas
appear as avascular masses, the echogenicity of which varies
depending on the age of the hematoma. 90 Associated indings
include scrotal hematomas, hematoceles, and wall thickening.
Complications of testicular rupture include infarction, chronic
pain, abscess, and infertility. Although ultrasound may aid in
evaluating the traumatized scrotum, controversy surrounds its
usefulness because some clinicians question its accuracy and
recommend early surgical exploration even in the absence of
testicular rupture. 146
Acute idiopathic scrotal edema is a rare cause of scrotal
edema that may involve one or both testes. It typically afects
boys 5 to 11 years of age, and presenting signs and symptoms
include scrotal swelling, erythema, and typically no pain 148 (Fig.
54.43). Swelling may extend to the anterior abdominal wall and
perineum. Sonographic indings include marked thickening of
the scrotal wall, with normal testes and epididymides. 91,97,148,149
Color Doppler imaging may show normal or slightly increased