Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage

Abstract

We describe the use of contrast-enhanced ultrasound as an additional imaging technique during an ultrasound examination of a traumatised testis, allowing for confident testicular preserving surgery to be performed.

Figure 1

Longitudinal image of the right testis, with an enlarged upper pole (star) and several areas of low reflectivity at the site of trauma (arrows).

Figure 2

Longitudinal image of the right testis, with colour Doppler mode, demonstrating a paucity of colour Doppler flow to the entire right testis, with pockets of colour signal (arrows); likely to be artefact.

Figure 3

Longitudinal image of the right testis with microbubble contrast imaging, 24 s after administration of SonoVue™ (Bracco SpA, Milan, Italy), demonstrating a clear demarcation between vascularised and non-vascularised tissue (arrows).

Figure 4

(a) At surgical exploration, the tissue of the upper third of the testis (arrow) is “dusky” without demonstrable blood flow. This ischaemic area is excised with preservation of the remainder of the testis. (b) Following non-viable tissue excision, the testis is reconstructed and secured as shown.

Figure 5

(a) Longitudinal image of the right testis 3 months post-surgery demonstrating an area of altered reflectivity at the upper aspect of the testis (arrow). (b) Contrast-enhanced ultrasound of the right testis at 47 s after administration of SonoVue™ (Bracco SpA, Milan, Italy), demonstrating perfusion of the entire remaining right testis.