This video shows Traumatic injury to Testes resulting in intra-testicular Hematomas.
The case I am presenting has intra-testicular infected hematomas.
US images of the testes in a patient 5 weeks after scrotal trauma show a hypoechoic area with a fluid-debris level without any peripheral hyperemia. The diagnosis, based on clinical symptoms (pain and fever) and US findings, was an infected hematoma.
Testicular trauma is the third-most-common cause of acute scrotal pain and may result in various degrees of damage to the testes.
High-frequency ultrasonography with a linear-array transducer is the modality of choice for the initial evaluation of patients with acute scrotal pain after trauma. Testicular trauma is the third most common cause of acute scrotal pain. The US is useful in medical or surgical management because it reliably examines tunica albuginea rupture, intra- and extra-testicular hematomas, and testicular contusions. Color Doppler US allows direct evaluation of testicular perfusion and detection of uncommon conditions, such as testicular torsion, that may be associated with scrotal trauma.
US Technique
The scrotal US is performed with the patient lying in a supine position and with the scrotum supported by a towel placed between the thighs. The use of a 7-14-MHz high-frequency linear-array transducer is preferred. After trauma, the scrotum is often tender to the touch, which makes scanning difficult. An attempt should be made to evaluate both testes and epididymides to identify any extra-testicular collections.
The testes are evaluated both in longitudinal and transverse planes. The size and echogenicity of each testis and epididymis should be compared with those of the contralateral testis and epididymis. Transverse scrotal imaging to depict both the testes is extremely important, allowing a comparison of their gray-scale and color Doppler appearances. The asymptomatic side should be scanned first to set the gray-scale and color Doppler gains to allow optimal comparison with the affected side. Color Doppler and pulsed Doppler US should be optimized to depict low flow velocities, and blood flow in the testis and surrounding scrotal structures should be documented by acquiring Doppler spectra of the intratesticular arterial flow in both testes.
Testicular rupture and testicular ischemia/infarct are two severe complications which need to be ruled out. Other injuries that can occur include :
1). Testicular fracture
2). testicular dislocation
3). Testicular torsion
4). Intratesticular hematoma
5). Intratesticular pseudoaneurysm
Associate injuries
Associated extra-testicular injuries (e.g. epididymis fracture, epididymitis, scrotal wall hematoma, hematoceles can also commonly occur.
The US appearance of a hematoma depends on the time elapsed between the occurrence of trauma and the US evaluation. Hyperacute and acute hematomas are sometimes difficult to identify, as they may appear isoechoic to the surrounding testicular parenchyma or may have a diffusely heterogeneous echotexture. For this reason, suspected acute hematomas are re-examined within 12-24 hours after the initial US evaluation to allow observation of any changes in their echogenicity.
Chronic hematomas appear more hypoechoic to anechoic and tend to decrease in size as they resolve. Color Doppler imaging helps to differentiate such hematomas from tumors, which are included in the differential diagnosis of intratesticular focal lesions. Hematomas demonstrate an absence of internal vascularity, but, when infected, an increase in peripheral hyperemia.
Негізгі бет Ultrasound Video showing Traumatic injury to Testes resulting in intra-testicular Hematomas.
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