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(®)). 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.

Keywords: Acute scrotum; Contrast media; Contrast-enhanced sonography; Scrotal trauma; Sonography.

Figure 1

False negative US finding in a case of testicular rupture. US (a) reveals only a single intratesticular lesion (arrow). CEUS documents the presence of hypoperfusion caused by contusion injury to the upper mid-polar region, which was not seen on US (b, arrow), interruptions of the tunica albuginea (c and d arrows), and concomitant hematocele.

Figure 2

False negative US finding in a case of testicular rupture. (a) CEUS shows evidence of substantial loss of tunica albuginea (arrow). There is also evidence of nonperfusion related to extensive lacerocontusive injuries to the lower anterior mid-polar region at 35″ (b) and minimal perfusion at 106″, which were not seen on the US study, and concomitant hematocele.

Figure 3

The basic US examination reveals a hypoechoic band extending from the anterior to the posterior margin of the lower peripolar region (arrow), which is suggestive of fracture (a). CEUS reveals accentuated locoregional perfusion (arrow) that is already evident in the early phase (b) and decreases progressively without disappearing in the later phases, findings indicative of an arteriovenous malformation.

Figure 4

The basic US examination reveals (a) areas of spontaneous non-calcific hyperechogenicity that were suggestive of focal intratesticular hemorrhages. The absence on CEUS of hypovascular areas or bands within the testis (b,c) together with inhomogeneous enhancement, in some cases focal, excluded the possibility that the lesions seen on the basic examination were traumatic. Indeed they were ultimately diagnosed as hamartomas related to the Cowden syndrome.

Figure 5

Basal US assessment with color Doppler is suggestive of lacerocontusive foci with interruption of the tunica albuginea (a). CEUS reveals focal contusions and lacerocontusions with no evidence of tunica albuginea discontinuity (b,c).

Figure 6

Multifragmented rupture (a). Power Doppler after administration of contrast agent reveals extravasation (arrow) caused by active hemorrhage (b).