II4 J. REYNARD
Usually, however, a force that is sufficient to rupture the tunica albuginea will also usually rupture the parietal layer of the tunica vaginalis. Seminiferous tubules and blood extrude into the layers of the scrotum and a substantial haematoma may develop (Fig. 5.25).
The patient is usually in severe pain and may have nausea and vomiting. The testis may be surrounded by haematoma and therefore may not be palpable. If it is possible to palpate the testis, it is usually very tender. The degree of scrotal swelling does not always correlate with the presence of testicular rupture, since as stated above in some cases bleeding from the ruptured testis may be confined (tamponaded) by the parietal layer of the tunica vaginalis and the testis may be only slightly enlarged. The slightly enlarged testis, following trauma, may be at risk for pressure-induced ischaemia.
The scrotal haematoma resulting from a rupture of the testis and both layers of the tunica (visceral and parietal) can be very large, and the bruising and swelling so caused may as a consequence spread into the inguinal region and lower abdomen.
S. TRAUMATIC UROLOGICAL EMERGENCIES II5
Figure 5.26. A normal testicular parenchymal echo pattern.
Testicular Ultrasound in Cases of Blunt Trauma
This helps decide whether or not scrotal exploration and testic-ular repair is necessary. A normal parenchymal echo pattern (Fig. 5.26) suggests there is no significant testicular injury, i.e., no tes-ticular rupture. The presence of hypoechoic areas within the testis suggests testicular rupture. This is the presence of intra-
116 J. REYNARD
FIGURE 5.27. Intraparenchymal haemorrhage within the testis.
parenchymal haemorrhage (Fig. 5.27), the expansion of which may be limited if the tunica albuginea and/or the pariteal layer of the tunica vaginalis are intact (haematocele), or may expand into the scrotum (haematoma). The tear in the tunica may or may not be seen. The absence of a tear in the tunica does not imply the absence of a rupture of the testis.