Bedside Ultrasound in a Case of Blunt Scrotal Trauma
A 22-year-old male with no significant past medical history presented to the Emergency department approximately 3 hours after he was in an altercation, during which he sustained multiple blows to the head, stomach, and genital area with a large flashlight. His primary complaint was of severe testicular pain.\nPhysical examination revealed a calm, well-developed male in mild distress due to pain. Vital signs included a blood pressure 132/85 mmHg, heart rate of 90 beats per minute, respiratory rate 16 breaths per minute, and temperature 98.9°F. On examination of the genitals, the penis was normal. His scrotum was enlarged to approximately the size of a grapefruit, and the overlying skin was erythematous. The scrotal area was exquisitely tender to palpation, making it impossible to reliably identify or examine either testis, despite the use of parenteral opioid analgesia. A urinalysis was obtained, which was normal and notably negative for blood.\nA bedside scrotal ultrasound was then performed utilizing a 10 MHz linear array probe. The right testicle and epididymis appeared normal. Normal perfusion was present within the right testis on Color Flow Doppler ultrasound. The left testis had ill-defined margins and diffuse irregularity of the outer contour. The tunica albuginea was disrupted, with protrusion of testicular parenchyma. A hematocele was present surrounding the defect (\n). The testicular parenchyma had a distinct area where poor vascular perfusion was noted on Color Flow Doppler imaging, consistent with ischemia (\n).\nUrology consultation was emergently requested and a formal ultrasound ordered, which confirmed the diagnosis of testicular rupture, with both sub-tunical and extra-tunical hematoma. Color Doppler Flow on the formal ultrasound also confirmed decreased flow in a portion of the left testis adjacent to the rupture, thought to be an area of infarction.\nThe patient was admitted by the urology service and promptly taken to the operating room. After dissection through the skin and layers superficial to the tunica, a 4 cm laceration was noted in the tunica albuginea. Necrotic testicular parenchyma was identified and excised. The remaining viable tissue was left and the tunica albuginea was closed. Following surgery, the patient did well post-operatively and was discharged from the hospital. Unfortunately, long-term follow up on the patient’s progress was limited by his failure to return for clinic appointments or respond to telephone calls.