Sound Bite 8 - Acute Testicular Pain

Author: Dr Julia Burkert-Milone Editor: Dr Nick Mani

A 17 year old male comes to the Emergency Department with sudden onset of left testicular pain. The day before he was hit by a baseball in the groin, which was very tender initially but it settled on its own. Today he woke up and noticed that the left testicle was very swollen and slightly bruised.

On examination, the left testicle is swollen, bruised and tender with a normal lie and cremasteric reflex . You elect to perform POCUS of the testicles as an extension of standard clinical assessment:

Clips- 1st clip comparing both testicles side by side in short axis, with right normal and left clearly abnormal (opposite way around). 2nd clip shows significantly enlarged left testicle in the oblique/long axis with anechoic fluid around it (likely traumatic hydrocele), and hyperechoic mass in the parenchyma with rim of anechoic fluid (likely acute haematoma/associated inflammation) 

The POCUS findings in the context of the standard clinical assessment is more likely to be due to acute trauma to the left testicle. Addition of colour/power doppler would have helped (not performed), which would have likely to have shown increased blood flow in the abnormal testicle due to ongoing acute inflammation +/- bleeding. The findings are unlikely to be due to testicular torsion.

Case Resolution

The urology team was consulted urgently, who reviewed the images and agreed with the overall impression, arranged a departmental ultrasound, and managed the patient nonoperatively.