Intralesional Doppler Flow in Acute Scrotal Trauma Revealing Testicular Germ Cell Tumor: An Emergency Imaging Pitfall.
Andrea Carolina Munive, Isabella Andrea Bolaños Bermúdez, Maria José Gutierrez Sierra et al.
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Case in brief
A 39-year-old man developed acute right testicular pain after minor blunt trauma. Ultrasound showed a heterogeneous intratesticular lesion with internal Doppler flow, an appearance atypical for traumatic hematoma or infarction and concerning for malignancy. Elevated serum alpha-fetoprotein and β-human chorionic gonadotropin supported that suspicion. Radical orchiectomy confirmed a mixed postpubertal germ cell tumor.
What made this case unusual
The lesion’s internal Doppler vascularity during an acute post-traumatic presentation was a clue against assuming hematoma or infarction and toward an underlying tumor.
Diagnostic / clinical pearl
In acute scrotal trauma, assess intratesticular lesions with Doppler; internal vascularity may prompt consideration of malignancy rather than traumatic hematoma or infarction.
Why it matters
The case illustrates how anchoring on trauma can obscure a malignant diagnosis during emergency imaging assessment.