Multiparametric Sonography of Testicular Hematomas

Abstract

We investigated the appearances of intratesticular hematomas on multiparametric sonography combining grayscale, color Doppler, and contrast-enhanced sonography and strain elastography. Over a 3-year period, 17 hematomas in 8 patients were analyzed. Blunt trauma (n = 7) and surgery (n = 1) were preceding events. Grayscale sonography showed well-defined oval or round predominantly hypoechoic and heterogeneous, peripherally (n = 13) or centrally (n = 4) located lesions. Three showed contrast enhancement of septations, and 4 showed peripheral lesion rim enhancement. On strain elastography, the mean strain ratio was 1.19 (range, 0.41-2.36), and elasticity score were 3 or lower (n = 13) and 5 (n = 4). Multiparametric sonography shows nonenhancement with contrast and predominantly "soft" elastographic properties and aids in the interpretation of the benign nature of intratesticular hematomas.

Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions

“…6). Focal lesions can often be recognized as harder than the surrounding testicular tissue, with some important exceptions reported with hematomas or mixed fluid lesions (Patel et al ., 2014; Yusuf et al ., 2015). Normal testis parenchyma is hard, but compared with the even harder solid tumorous tissue, it has a relatively softer appearance, displaying areas of green and light blue (Jedrzejewski et al ., 2013).…”

“…Its output include a color‐coded representation (qualitative assessment) of the lesion and a semi‐quantitative characterization by strain ratio, calculated as the ratio of the surrounding parenchyma to the lesions and providing a measure of lesion stiffness. SE has been successfully used in the evaluation of acute scrotal pathology (Shah et al ., 2010; Patel et al ., 2014; Yusuf et al ., 2015). However, to date, only a few studies (Schurich et al ., 2009; Grasso et al ., 2010; Aigner et al ., 2012; Huang & Sidhu, 2012; Patel et al ., 2012; Marsaud et al ., 2015) and just one prospective study (Goddi et al ., 2012) have explored the role of SE in focal testicular lesions.…”

Elastography of focal testicular lesions: current concepts and utility

“…A variety of non-neoplastic intratesticular abnormalities may present as focal intra-testicular abnormalities, causing a diagnostic conundrum. These indeterminate tumor-like lesions include focal abscesses, prominent retia testis, hematomas [3], segmental testicular infarctions [26,27], venous infarctions [28], focal orchitis, and sarcoidosis [16]. The majority of non-neoplastic testicular lesions do not require surgical management, unlike the majority of neoplastic lesions, for which orchidectomy or testicular-sparing surgery is essential.…”

Comparison of Tissue Stiffness Using Shear Wave Elastography in Men with Normal Testicular Tissue, Testicular Microlithiasis and Testicular Cancer

“…Elastography is used in various organs 7 9 10 11 and also in the testicles for investigating testicular torsion 12 13 , testicular cancer 14 15 infarction 16 17 , epidermoid cysts 18 , undescended testes 19 , infertile men 20 , hemodialysis patients 21 , testicular microlithiasis, and other lesions 22 23 24 . It can be challenging to distinguish hard tumors in soft tissue using only B-mode ultrasound.…”