Rare Medical Case: Man’s Testicle Ruptures from Coughing | First in History

April 10, 2025   85

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Rare Case: Tennessee Man’s Testicle Ruptures from Coughing Due to Heart Failure Complications

In a truly unique and groundbreaking case that underscores the importance of early diagnosis and chronic disease management, a 68-year-old man from Tennessee suffered a spontaneous rupture of his right testicle during a coughing fit. This event, detailed in a medical case report by Dr. Shawhin Shahriari and colleagues in Cureus, marks the first-ever recorded case of non-traumatic testicular rupture triggered solely by coughing.

Patient Background and Symptoms

The patient urgently arrived at the emergency department, reporting sudden and severe pain in his right scrotum, followed by rapid swelling. These alarming symptoms developed immediately after a forceful coughing episode. Importantly, the patient had new-onset congestive heart failure, a condition known to affect vascular health and tissue integrity.

Upon examination, doctors noted a tense, swollen, and tender scrotum. An ultrasound revealed a complete rupture of the testicle, along with a large hematocele — internal bleeding into the scrotal sac. The testicle's protective outer layer, the tunica albuginea, was completely torn.

Diagnostic Accuracy Saves Time and Tissue

In scrotal emergencies, time is a critical factor. Accurate and immediate diagnosis using scrotal ultrasound allowed the medical team to identify the rupture quickly and begin emergency treatment. In this case, because the rupture was severe and the tissue nonviable, a right-sided orchiectomy (surgical removal of the testicle) was necessary.

Had there been a delay in evaluation, complications such as infection, abscess formation, or even life-threatening sepsis could have developed.
 

📸 Clinical Ultrasound Image

Image source: Shahriari S, et al. Spontaneous Rupture of the Testicle Secondary to Coughing in a Patient With New-Onset Heart Failure: A Case Report. Cureus. 2024. Link

Figure description: Right testicle ultrasound showing heterogeneous echotexture and associated hematocele following spontaneous rupture due to coughing.

Image credit: Shahriari S, et al. / Cureus, 2024. Licensed under CC BY 4.0.

Why Early Detection and Chronic Care Matter

This rare case reminds us that routine health monitoring and early detection of systemic conditions—such as heart or lung disease—can prevent unexpected and extreme complications.

Congestive heart failure, which weakens blood vessels and tissues, played a significant role in this case. Persistent coughing, associated with pulmonary congestion or fluid buildup, led to a dangerous increase in intra-abdominal pressure, which overwhelmed the testicle's structural integrity.

Regular checkups, early cardiac assessments, and management of symptoms like chronic coughing may have reduced the risk of this severe outcome.

Clinical Significance and Lessons for Practitioners

• Non-traumatic testicular rupture is possible in patients with cardiovascular and respiratory compromise.

• Prompt scrotal imaging should be standard in cases of acute scrotal pain, regardless of reported trauma. This proactive approach can help in early diagnosis and prevent severe outcomes.

• Empowering patients with knowledge on symptom reporting and compliance with treatment plans is vital, especially in older adults with multiple comorbidities. This education can significantly improve patient outcomes and reduce the risk of severe complications.

Final Thoughts

Though highly unusual, this case highlights how even a common symptom like coughing can lead to serious consequences when chronic health conditions occur. It also emphasizes the critical importance of timely medical evaluation and effective heart and lung disease management.

Patients and providers should remember that early diagnosis, routine monitoring, and proactive care are not just recommendations—they are lifesaving tools.

For further reading, the whole medical report can be accessed via Cureus.