Diagnostic ultrasound ( PDFDrive )

848 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
F
G
H
I
FIG. 22.31, cont’d. (F) Longitudinal gray-scale scan with 3 weeks of epididymo-orchitis unresolved with antibiotic therapy shows hypoechoic
areas in the testis and an enlarged heterogeneous tail of the epididymis. (G) Color Doppler image shows increased low in the testis and epididymis
with an area of decreased low due to ischemia (arrow). (H) and (I) Acute orchitis. Longitudinal gray-scale and color Doppler images show
hypoechoic bands caused by septal accentuation from edema and increased vascularity of the testis. See also Video 22.6.
direct relationship between early surgical intervention and
testicular salvageability. Approximately 90% of ruptured testes
can be saved if surgery is performed within the irst 72 hours,
whereas only 45% may be salvaged ater 72 hours. 198
Sonographic features of testicular rupture include focal areas
of altered testicular echogenicity, corresponding to areas of
hemorrhage or infarction, and hematocele formation in 33% of
patients. A discrete fracture plane may not be identiied. Tunical
disruption associated with extrusion of the seminiferous tubules
is speciic for rupture (Fig. 22.35E, Video 22.7). However, the
sensitivity of the diagnosis of rupture based on tunical disruption
alone is only 50%. Heterogeneity of the testis with associated
testicular contour irregularity may be helpful in making the
diagnosis of rupture. 110,199,200 Color Doppler imaging can be helpful
because rupture of the tunica albuginea is almost always associated
with disruption of the tunica vasculosa and loss of blood supply
to part or all of the testis. 110 Although not speciic for a ruptured
testicle, these features may suggest the diagnosis in the appropriate
clinical setting, prompting immediate surgical exploration.
Clinical diagnosis is oten impossible because of marked scrotal
pain and swelling; thus sonography can be invaluable in the
assessment of tunica albuginea integrity and the extent of testicular
hematoma. 110,198-200 A visibly intact tunica albuginea should exclude
rupture, but a complex intrascrotal hematoma may be diicult
to distinguish from testicular rupture and may obscure the
tunica 110,201 (Fig. 22.35A). Patients with large intrascrotal hematomas
or hematoceles will oten undergo surgical exploration
because it is diicult to exclude rupture sonographically in the
presence of surrounding complex luid. 110 If a patient with a
presumed intratesticular hematoma is not surgically explored,