Post Traumatic Hematocele - Ultrasonography and Elastography Imaging

Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Elastography is the new recent advance in the field of ultrasound. USG and elastography findings of the acute hematocele is described in this aricle. Testicular trauma is the third most common cause of acute scrotal pain,1 and high-frequency ultrasonography (USG) with a linear array transducer is the first preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, spontaneous resolution occurs with the support of conservative therapy,3 even if treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed broad hematoceles and testicular hematomas over time.4 A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. A typical testis is 5 x 3 x 2 cm in diameter and has an intermediate echogenicity. The tunica albuginea is a fibrous covering that protects the testis from damage from the external injuries. It is located on top of the tunica vasculosa, which is made up of capsular arteries. A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. With its high tensile strength, the tunica albuginea plays an important role in shielding the testis from trauma. It can withstand a force of up to 50 kg without bursting. The testicular parenchyma is made up of several lobules, each of which is made up of several seminiferous tubules that lead to dilated spaces inside the mediastinum called the rete testis through the tubuli recti. The epididymis is made up of a head, neck, and tail that protects the superolateral part of the testis. The epididymis' tail ends in the spermatic cord as the vas deferens. The epididymal head is a 5 – 12 mm pyramidal structure that sits atop the testis' superior pole. The head is almost isoechoic to the testis. The epididymis has a 2 – 4 mm thick body.5 The patient lies in a supine position with the scrotum covered by a towel positioned between the thighs during scrotal ultrasound. A high-frequency lineararray transducer with a frequency range of 7 – 14 MHz is preferred. The scrotum is always soft to the touch after trauma, making scanning difficult. It should be attempted to examine both the testes and the epididymis in their entirety, as well as any extra testicular lesions. The testes are assessed in two planes: longitudinal and transverse. Each testis and epididymis should be compared to the contralateral testis and epididymis in terms of size and echogenicity. Transverse scrotal imaging is important for depicting both testes and comparing their gray-scale and colour Doppler appearances.