The tunica albuginea is a dense fibrous capsule surrounding the testis. Discontinuity of the tunica albuginea on ultrasound is diagnostic of testicular rupture — a urologic emergency that requires immediate surgical repair to preserve testicular function and viability. Early surgical intervention within 72 hours has a high success rate for testicular salvage (up to 90%).
Intratesticular hematoma (A) may be managed conservatively if the tunica albuginea is intact.
Heterogeneity of the parenchyma (C) indicates injury but not necessarily rupture.
Increased vascularity (D) may be seen with inflammation or reperfusion but does not mandate surgery unless rupture is present.
Reference Extracts:
Dogra VS, Bhatt S. "Acute painful scrotum: ultrasound evaluation." Radiologic Clinics of North America. 2004; 42(2):349-363.
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