COTW October 4th: A 57 year old with scrotal pain...
A 57 year old man presented to the ED with 3 days of unilateral testicular pain. No associated trauma.
Exam shows a large swollen R testicle that is exquisitely tender to palpation.
Bedside ultrasound as follows:
The testicle is hypoechoic to normal testicular tissue and has a reactive hydrocele.
Note the absence of venous and arterial wave forms on pulse wave doppler.
When compared with the contralateral testicle there is absent flow on power doppler.
Patient was taken immediately to the OR, however despite de-torsion, orchiectomy and orchipexy was performed.
Learning points:
Know what a normal testicle looks like. The testicle should be homogeneous and have the echo texture of liver/thyroid. See below:
ALWAYS COMPARE BOTH SIDES!
Use power doppler and pulse wave doppler to compare flow and evaluate for both venous and arterial pulsations.
Start by using power doppler and compare both testes, then use pulse wave doppler in these areas to get your waveforms.
Arterial waveform (left) Venous (right) (Radiopaedia.org)
Then look for secondary signs such as scrotal wall thickening, reactive hydrocele, and asymmetry in size and echogenicity.