Testicular Rupture: A Tough Nut to Crack

Abstract

Blunt scrotal injury represents a diagnostic dilemma for emergency physicians (EP). Consequently, point-of-care ultrasound (POCUS) has emerged as a tool for early investigation of the acute scrotum in the emergency department. We describe a case where an EP used scrotal POCUS to immediately visualize the loss of testicular contour and underlying heterogeneous parenchyma to rapidly make the diagnosis of testicular rupture in a young male presenting with scrotal trauma. The use of POCUS in this case expedited therapy, likely improving the patient’s outcome. To our knowledge, this is the first detailed description of testicular rupture diagnosed with POCUS by an EP

Testicular Rupture: The Other Nutcracker Syndrome

“…The anatomical lay of the testes in combination with the increasing use of protective cups has made this an increasingly uncommon event. 1 The right testis is more commonly injured due to its position and propensity in being trapped against the pubic bone. Previous studies have revealed that about 50 kg of force is required to rupture a testis.…”

“…Previous studies have revealed that about 50 kg of force is required to rupture a testis. 1 , 2 The clinical examination of the traumatized scrotum can be challenging due to the pain and swelling with misdiagnosis often common. Due to misdiagnoses, there has been an increased rate of traumatic sequelae to include: orchiectomy, atrophy, and infertility.…”

Testicular Rupture Following Blunt Scrotal Trauma

“…Previously reported rates of testicular injury with sports participation may underestimate the prevalence of these injuries among adolescent and young adult athletes among whom testicular protective equipment is infrequently used. Any kind of contact sport, without the use of protective aids, may be associated with genital trauma [4,5].…”

“…Point-of-care ultrasound (POCUS) has increasingly been used for early investigation of the acute scrotum [4]. However, the literature is limited to case reports, and two retrospective studies [1,4,5,9,11]. Using a high frequency linear array probe, the testes should be individually visualized.…”

“…Testicular rupture is a rare but serious injury and appropriate evaluation and timely management are necessary both for symptom control, but also for preservation of the testicle [3]. However, clinical signs may be inconsistent, and investigations are not always de nitive in establishing the diagnosis [4].…”