ACCURACY OF ULTRASOUND IN DIAGNOSIS OF RUPTURE AFTER BLUNT TESTICULAR TRAUMA ROLAND UGARTE, M.D. MELANIE SPAEDY, M.D. A. S. CASS, M.B.B.S. From the Division of Urology, Hennepin County Medical Center, Minneapolis, Minnesota

A B S T R A C T - - I n 6 patients who underwent ultrasound scanning and operation after blunt testicuiar trauma, the scan suggested the correct diagnosis in only 2 patients. There was one false-positive and three false-negative diagnoses of rupture. Absence of firm diagnostic criteria for rupture and high error rates with various criteria now in use make reliance on ultrasound in the diagnosis of :testicular rupture inappropriate at this time.

Recent reports suggest that ultrasound can diagnose testicular rupture accurately after ;blunt trauma, 1-4 and some authors advocate asonography should be done in path testieular trauma to determine an operation is necessary. ''2 Despite usiasm, the diagnostic accuracy of ulas judged by the results of surgical exhas been inconsistent in various stud:t because of lack of standard criteria agnosis of rupture.

1 ease and rupture of the superior pole with subcapsular hematoma in the other (Fig. 1). In 3 other eases, ultrasound failed to suggest rupture that was present (false-negative result). In 2 of these patients, ultrasound indicated a small

Material and Methods ,~ From 1986 to 1988, 10 patients with blunt 191~ticular trauma (bilateral in 1 case) had ultra:~hography using real-time machines at 7 5 to ii~i~i0 mHz Six patients underwent surgical ex~ii~ioration because the entire testis felt abnormal palpation or could not be palpated due to hematoeele present. Results and Comment the 4 patients who were not operated on, iaeInultrasound findings did not suggest rupture, ~d the subsequent clinical course suggests that :~pture indeed was not present. In 2 patients on, ultrasound suggested the correct which was subcagsular hematoma in

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FmunE 1. Twenty-three-gear-old patient with tender scrotal mass and nonpalpable testis after motorcycle accident. Ultrasound shows subcapsuIar hematoma and blood outside adjacent part of testis. Exploration revealed rupture with subcapsular hematoma.

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FIGURE 2. Nineteen-year-old patient with a tender scrotal mass and nonpalpable testis after being kicked. Ultrasound shows multiple intratesticular hypoechoic areas and large collection of fluid outside testis. Exploration showed large hematocele, rupture of testis and subcapsular hematoma.

hematocele with an intratesticular hematoma, whereas the final diagnosis was a lower-pole rupture and intratesticular hematoma. In the other case, ultrasound correctly identified a large hematocele but suggested only intratesticular hemorrhage when the final diagnosis was large hematocele, rupture of the lower pole, and subcapsular hematoma (Fig. 9.). In the final patient who was operated on, ultrasound showed intratesticular hematoma and possible rupture, whereas only a subcapsular hematoma was found at operation (false-positive result).

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Published results are similarly unsupportive of the accuracy of ultrasound in the diagnosis of testicular rupture. Adding our data on p a t i e n t s : with operation-confirmed diagnoses to similar :: data from five published series 2-~ shows seven false-negative and nine false-positive diagnoses of rupture among 27 patients. Moreover, a l , though some authors claim that intratesticular hypoechoic areas indicate rupture, in our experience, such an area is only a hematoma unless there is disruption of the testicular margin with or without an extratesticular mass (representing: hemorrhage in the tunica vaginalis sac). Even this finding is not conclusive, however, as Lu, i petin~et al. 5 recorded findings only of a necrotic ~ testis with hematoeele in a patient with intra- i) testicular inhomogeneous echoes, a poorlyi:i marginated testis, and a complex extratesticular::il mass on ultrasound. Because there is no consistent view of wha[ ultrasound findings are diagnostic of testicular rupture after blunt trauma, more evaluation: needs to be done before one can advocate rely! ing on the diagnostic accuracy of this study. Minneapolis, Minnesota 55415 (MR. CASS)i:! References 1. Fournier CR Jr, Laing FC, Jeffrey RB, and MeAnineh JWi High resolution serotal ultrasonography: a highly sensitive bu! nonspeeifie diagnostic technique, J Urol 134:490 (1985). 2. Anderson KA, MeAnineh JW, Jeffrey RB, and Laing Ultrasonography for the diagnosis and staging of blunt scrotaii~~ trauma, J Urol 130:933 (1983). }i~ 3 Albert NE: Testieular ultrasound for trauma, J Urol 124!i~

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558 (198o).

4. Friedman SG, Rose JG, and Winston MA: Ultrasound ani nuclear medicine evaluation in acute testicular trauma, J ur~ 125:748 (1981). 5. Lupetin AR, King WIII, Rich PJ, and Lederman RB: Th~ traumatized scrotum: ultrasound evaluation, Radiology 148: 2( (1983). ~ 6. Vaecaro JA, David R, Belville WD, and Kiesling VJ: Trad~ matic hematocele: association with rupture of the testicle, J Uro~ 136:1217 (1986). :;~?~

UROLOGY / SEPTEMBER 1990 / VOLUME XXXVI, NuMBEli'3~

Accuracy of ultrasound in diagnosis of rupture after blunt testicular trauma.

In 6 patients who underwent ultrasound scanning and operation after blunt testicular trauma, the scan suggested the correct diagnosis in only 2 patien...
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