27 y/o M presented wit scrotal pain upon awakening after a night of heavy drinking. He could not recall any trauma. Physical exam revealed a tender, swollen, and ecchymotic scrotum. POCUS demonstrates hematocele, as well as (1) disruption of the tunica albuginea, (2) contour abnormality of the testis, and (3) heterogeneous echotexture of testicular parenchyma. These three findings collectively are highly sensitive and specific for testicular rupture1-3, and warrant urgent surgical exploration.
Elizabeth Hanson, MD - EM resident, Kings County/SUNY Downstate
1. Deurdulian C, Mittelstaedt CA, Chong WK, Fielding JR. US of acute scrotal trauma: optimal technique, imaging findings, and management. RadioGraphics2007; 27: 357–369.
2. BuckleyJC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol2006; 175: 175–178.
3. Micalle FM, Ahmad I, Ramesh N, Hurley M, McInerney D. Ultrasound features of blunt testicular injury. Injury2001; 32: 23–26.
WCUME 2017 Submission and WINNER for "Creative Caption" Category
"Stone in the Sword"
The patient presented with penile pain and blood in urine. POCUS demonstrates a calculus obstructing the distal urethra.
Inna Shniter, MD - UCI Ultrasound Fellow
A patient presented for worsening, severe scrotal pain. Point-of-care ultrasound demonstrated a normal appearing testicle with an associated hydrocele. Significant ring down artifact is visualized posterior producing a “dirty shadow”. The patient was taken to the operating room where the ring down artifact was confirmed as significant subcutaneous air associated with a necrotizing infection.
By: Michael Schick DO, Emergency Physician
83 y/o M with R testicular swelling, tenderness, concern for epididymitis vs orchitis. POCUS with septated fluid collection concerning for pyocele.
Pycoeles are a urologic emergency that can lead to Fournier's and often require orchiectomy.
Dr. Tess Sexton - Kings County/SUNY Downstate EM