Testicular Rupture: A Force of 50kg
Amy Duggan1, Yvonne Green2, Therese Herlihy1, Kevin Cronin1, 1University College Dublin, School of Medicine, 2Ultrasound Mater Misericordiae University Hospital
Background:
This poster displays the application of ultrasound in the diagnosis of testicular rupture. A 27-year-old male presented to the ED with left testicular pain, 72 hours post blunt testicular trauma sustained during football training. Testicular rupture, one of the most common complications of blunt testicular trauma, is the rupture of the tunica albuginea and extrusion of testicular parenchyma. A force of approximately 50kg is required to rupture the tunica albuginea. Patients clinically present with testicular swelling, tenderness and severe pain. Many studies have reported testicular ultrasound to be fast and reliable in differentiating a broad range of time-sensitive pathologies, including testicular torsion, fracture, and rupture.
Ultrasound Findings:
Sonographic findings demonstrated an enlarged, heterogenous left testicle with disruption of the tunica albuginea indicating testicular rupture. There was an irregular contour of the left testicle and evidence of intra-testicular haematoma on B-mode imaging. The lower pole demonstrated absent perfusion on colour Doppler, providing useful information to the surgeon regarding the extent of debridement.
Discussion:
Ultrasound has a sensitivity of 100% and specificity of 65% in the detection of testicular rupture. Current management of testicular rupture is surgical exploration and repair, or orchiectomy. Prompt surgical intervention is critical in preventing testicular loss. When presentation occurs within 72 hours of injury there is a 90% salvage rate, this is reduced to only 30% salvage rate after 72 hours.
Conclusion:
Ultrasound is the modality of choice for the evaluation of blunt testicular trauma due to its high sensitivity and efficiency in assessing the integrity of the testis and vascular perfusion. Ultrasound findings can guide the physician in determining optimal treatment. Testicular rupture requires early surgical intervention to improve testicular salvage rates. Ultrasound was paramount in the diagnosis of testicular rupture in this case.