ABSTRACT. We describe the use of contrast-enhanced ultrasound as an additional imaging technique during an ultrasound examination of a traumatised testis, allowing for confident testicular preserving surgery to be performed. Testicular trauma often arises as a consequence of a road traffic accident, a sporting mishap or a straddle injury. It tends to affect the younger male, in whom preservation of the testis is an important consideration. Clinical examination is difficult in the acute setting where establishment of the need for early surgical exploration is important and is notoriously inaccurate. Often greyscale ultrasound with the addition of colour Doppler techniques is the most useful investigation tool, readily identifying the appearance of testicular injury and so establishing the need for surgical exploration [1]. The appearances of testicular fracture, rupture, haematoma and haematocoele are readily identified on sonography, giving the surgeon a clear understanding of the status of the injury to the scrotal content and the need for exploration [2]. The establishment of continued blood flow to the injured testis has traditionally been based on the presence of colour Doppler signal; enabling the surgeon to tailor the surgery to either perform an orchidectomy or plan organ-sparing surgery. However, colour Doppler techniques have limitations; operator experience, movement artefact, patient discomfort and tissue reflectivity all play a part in diminishing the accuracy of the technique [3]. The use of contrastenhanced ultrasound (CEUS) is firmly established in many organs in the body, but less widely used in the testis [4]. CEUS is an ideal technique to ascertain the vascular supply to an organ, as the contrast agent is purely an intravascular agent and increases the sensitivity of detection of blood flow.We describe the use of CEUS as a tool for precise assessment of viable testicular tissue post-scrotal trauma, allowing a rapid and precise delineation of viable testicular tissue enabling organ-sparing treatment in testicular trauma. Case historyA 39-year-old male presented to the accident and emergency department following trauma to the right testis. The injury was sustained during a cricket match, when the patient collided with the wicket whilst fielding, not wearing any gonadal protection. There was no relevant medical or drug history and the patient was otherwise fit and well. On examination the right testis was swollen and tender, with difficulty in ascertaining the status of the contents of the scrotal sac. Observations were stable; blood biochemistry and haematology were unremarkable. An ultrasound examination was requested. An ultrasound examination was performed using a Siemens S2000 (Siemens, Mountain View, CA), with a linear array high frequency 9L4 transducer, with settings suitable for a scrotal examination. The left testis was unremarkable. The contour of superior pole of the right testis was ill-defined and suggestive of a tunica albuginea

• The classification of Aspergillus -related lung disease is mired in confusion. • The chronic form of Aspergillus infection is associated with significant morbidity and mortality. • Progressive consolidation and cavitation with intracavitary material is the radiological hallmark.

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