A 17-year-old student presented with pain and swelling of the right side of the scrotum following a cricket ball injury. After sustaining the injury, the right half of his scrotum swelled up immediately and continued to swell until the evening, after which it remained static. Following severe pain for 2 days he came to the A&E at Southmead Hospital.

On examination, his left testis was normal, but he had a swelling on the right side of the scrotum that was tense, red, warm and very tender. The cord was palpable above the swelling but the rest of his abdominal findings were unremarkable.

A clinical diagnosis of injury to the right testis and haematoma formation with possible rupture of the tunica albugenia was made. All routine investigations were normal. An urgent ultrasound scan revealed the following: