PMC5651116_01
Doppler ultrasound performed upon patient presentation demonstrating heterogeneous echotexture in both the testicle and the epididymis signifying ischemia and inflammation in the testicle and necrosis in the epididymis (red arrows). Only peripheral blood flow to the testicle is present while blood flow to the epididymis is maintained. Additionally, a significant hematoma is visualized on the anterior aspect of the testicle (green arrow).
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The ultrasound demonstrated prominent right epididymal vascularity and marked abnormality of the right testicle along with heterogeneous echotexture with solid sonographic characteristics throughout the right scrotal sac (Figure 1). Additionally, Doppler ultrasound demonstrated only peripheral blood flow and a lack of central flow to the testicle, while blood flow was preserved within the epididymis (Figure 1).
Histology of specimen collected intraoperatively demonstrating coagulative necrosis of epididymal tissue with surrounding hematoma.
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The hematoma and epididymis were sent for pathology, and histology confirmed that the specimen was comprised of necrotic epididymis and surrounding hematoma (Figure 2).
Doppler ultrasound on postoperative day one of the right testicle demonstrating robust return of vascular flow to the testicle following necrotic epididymis and hematoma excision.
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The patient was admitted for one day and received a follow-up ultrasound on postoperative day one which exhibited robust return of vascular flow to the right testicle, and he was discharged home (Figure 3).