Diagnostic ultrasound ( PDFDrive )

850 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
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FIG. 22.35 Testicular Trauma: Spectrum of Appearances. (A) Hematoma. Longitudinal image shows hematoma (arrows) on the anterior
surface of the testis. Tunica intact at surgery. (B) Fracture of testis. Transverse scan shows a heterogeneous testicle with a linear band (arrows)
indicating a fracture. H, Testicular hematoma. (C) Tunical tear. Longitudinal color Doppler image shows contour irregularity of the testis with disruption
of the tunica (arrow). Extruded testis parenchyma shows no color low. (D) Same case as C. Photograph during surgery shows tunical tear in the
exposed right testis. (E) Rupture of testis. Longitudinal image shows rupture of the testis with extrusion of seminiferous tubules (arrow). (F) In
same case as E, photograph during surgery shows a tear in the tunica inferiorly with extrusion of seminiferous tubules. (G) and (H) Fracture of
testis. Longitudinal and transverse color Doppler images of the left testis show an irregular linear, hypoechoic, avascular band representing a
testicular fracture following acute blunt trauma. The tunica albuginea was intact. See also Video 22.7.
it is incumbent upon the clinician to follow the intratesticular
abnormality to resolution because a testicular tumor can mimic
an intratesticular hematoma and also predispose to rupture
following relatively minor trauma.
Testicular fracture refers to discontinuity of normal testicular
parenchyma, which may be present in the absence of disruption
of the tunica albuginea. An associated intratesticular hematoma
or hematocele may be present. Sonographically, the fracture
appears as a linear, hypoechoic, avascular band extending across
the testicular parenchyma (Fig. 22.35).
Sonography can also be used to discern the severity of scrotal
trauma resulting from penetrating scrotal injury. Gunshot injury
is the most common cause; other causes include stabbing, self
mutilation, human and animal bites, and projectile injuries.
Bilateral injuries are more common in the setting of penetrating
trauma. 202 Penetrating trauma can disrupt the tunica albuginea,
as well as penetrate the parenchyma, causing a fracturelike injury.
Ultrasound can assess the degree of injury and evaluate for the
presence of foreign bodies and for the presence of air, which
may denote the path of the penetrating injury. 203 Doppler