Contrast-enhanced sonography in blunt scrotal trauma

Abstract

The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue Ò ). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series.Sommario Scopo del nostro lavoro è stato di valutare l'eventuale maggiore confidenza diagnostica e contenuto informativo dell'ecografia con mezzo di contrasto e.v. (CEUS) nel trauma scrotale chiuso rispetto all'indagine ecografica (US) di base. Nell'arco di 75 mesi abbiamo esaminato 40 pazienti consecutivi con trauma scrotale chiuso, utilizzando US ad alta risoluzione, color-power-Doppler basale, ecocontrastografia a basso indice meccanico, power Doppler dopo mdc e.v. Il mdc usato è stato il SonoVue Ò . Nei 24 casi positivi, la concordanza tra US basale e CEUS è stata di grado 0 (assente) in 4 casi, di grado 1 (bassa) in 3, di grado 2 (medio) in 8, di grado 3 (elevato) in 9. La rilevanza del contenuto informativo aggiuntivo della * Award for the best oral presentation at the XXII SIUMB National Congress.* Corresponding author. Radiology Department, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy. E-mail address: robertolobianco@virgilio.it (R. Lobianco).Available online at www.sciencedirect.com CEUS veniva ritenuta: elevata in 4/40 (10%), media 7/40 (17,5%), bassa 13/40 (32,5%), assente in 14/40 (35%). I nostri risultati mostrano che la CEUS migliora sensibilmente la detezione dei segni di trauma rispetto l'US basale, specialmente nelle piccole lesioni. Essa è inoltre importante nella diagnosi differenziale e marginalizzazione delle raccolte fluide corpuscolate, nelle fratture e, di grande evidenza, nelle rotture, che impongono l'immediato intervento chirurgico: nella nostra casistica 2 casi su 3 di rotture (67%) si sono resi evidenti soltanto alla CEUS. Riteniamo che l'uso della CEUS possa aumentare significativamente la co...

Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay.

“…Traumatic pathology of the scrotum and testicle is most frequently encountered in sports and motorcycle accidents [24]. Intra or peritesticular hemorrhages may be encountered, but the scrotal wall, the epididymis, and even the urethra may also be involved [25].…”

“…Conventional US is capable to identify testicular rupture with a Se of up to 100% and a Sp of 65% [28]. Additionally, US may show hyper of hypoechoic focii which correspond to hematomas, infarctions, or hematoceles [26], but cannot differentiate between herniated parenchyma and a hematoma with similar echogenicity [24]. CEUS examination can identify intratesticular fluid collections which develop early in a trauma, as well as their extent and the solution of continuity at the level of tunica albuginea [24].…”

“…Additionally, US may show hyper of hypoechoic focii which correspond to hematomas, infarctions, or hematoceles [26], but cannot differentiate between herniated parenchyma and a hematoma with similar echogenicity [24]. CEUS examination can identify intratesticular fluid collections which develop early in a trauma, as well as their extent and the solution of continuity at the level of tunica albuginea [24]. The CEUS exam has an im portant role in traumatic scrotal pathology in situations when conventional US cannot clearly establish if surgery is needed or not [5] (for example in the case of a hematocele without a clear testicular fracture line on the conventional US) or it cannot define the complete extension of the lesions (such as in the situation of a hematoma with an echogenicity similar with that of the testicular parenchyma or for the evaluation of the testicular tissue viability).…”

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

“…Testicular rupture -US is able to identify testicular rupture with 100% sensitivity and 65% specificity [127]. CEUS can identify intratesticular fluid collections, their extent and ruptures of the albuginea [128].…”

Can ultrasound help to manage patients with scrotal trauma?

“…The use of microbubble ultrasound contrast agents (CEUS) can also be used to determine testicular perfusion in trauma. 15 In one study of 40 patients presenting with blunt scrotal trauma, CEUS added additional ................................................................................................................... 16 The high-frequency transducers used for scrotal sonography are not ideally suited for contrast enhanced ultrasound, mainly because the current commercially available microbubbles resonate optimally at lower frequencies. For successful scrotal CEUS, the transducer frequency will often need to be reduced and a higher dose of microbubbles administered than for a standard abdominal CEUS study.…”