2091496 Multi-Parametric Ultrasonography of Testicular Hematomas: Features on Grey Scale, Color Doppler, Contrast Enhanced Sonography and Real-Time Tissue Elastography

Abstract

ObjectivesTesticular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography.MethodsHematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded.ResultsOver a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography.ConclusionsMulti-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances. ObjectivesTesticular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography. Testicular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography. MethodsHematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded. Hematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded. ResultsOver a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography. Over a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography. ConclusionsMulti-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances. Multi-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances.