Testis cancer incidentally found following delayed presentation of traumatic testicular rupture

A 31-year-old male with history of obesity, arthritis, and chronic back pain sustained blunt testicular trauma following a bicycling accident. He presented to the emergency department 3 weeks after the initial injury with complaints of right testicular pain and swelling. Scrotal ultrasound was concerning for testicular rupture (Fig. 1). Scrotal exploration with possible orchiectomy was recommended, however, he deferred surgery at that time and left the hospital against medical advice. Four months later, he returned with complaints of persistent right testicular pain, swelling, and scrotal enlargement. Repeat ultrasound demonstrated an irregular contour of the right testicle with parenchymal heterogeneity and preserved vascular flow. Notably, where there was prior concern for testicular rupture, follow-up ultrasound demonstrated increased vascularity. The differential diagnosis included malignancy, intermittent torsion, and prior testicular rupture (Fig. 2A and B). Tumor markers and urology consult were obtained. Serum bHCG was 37,963 IU/L,