음낭외상시 고환파열에 대한 초음파 검사의 진단적 유용성

The Diagnostic Effectiveness of Ultrasonography for Testicular Rupture in Scrotal Trauma

Purpose: We determined the use of scrotal ultrasonography in the initial diagnosis and management of testicular injuries due to blunt scrotal trauma. Materials and Methods: We reviewed 54 patients of scrotal trauma in the last 8 years. Forty patients were evaluated by ultrasonography preoperatively. A heterogeneous echo pattern of the testicular parenchyma with loss of oval shape, contour definition was the basis for diagnosis of testicular rupture. Among them, 33 cases underwent scrotal exploration and 7 cases were managed conservatively. The remaining 14 patients were evaluated only by physical examination, 8 patients of them were explored immediately because of suspicious testicular rupture. The accuracy of ultrasonography were determined by comparing radiographic interpretations with intraoperative findings. Results: Among the 33 patients who were evaluated by ultrasonography and explored immediately, there were 26 suspected testicular ruptures on ultrasonography. Surgical exploration revealed testicular rupture in 23 and simple hematoma in 10. The testicular rupture was correctly diagnosed by ultrasonography in the 22 cases, and there were 4 false-positive and 1 false-negative diagnoses of testicular rupture. The sensivity and specificity for the diagnosis of testicular rupture are 96% and 60%, and the positive and negative predictive values are 85% and 86%, respectively. Conclusions: Scrotal ultrasonography, with the main radiographic finding of a heterogeneous echo pattern of the testicular parenchyma with loss of oval shape, contour definition, is highly sensitive on the diagnosis of testicular rupture. And it increases the salvage rate for testicular rupture with preservation of the testicular function and prevents delayed complications of chronic pain, atrophy and orchiectomy associated with missed testicular rupture.