KEY FACTS
Imaging
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Heterogeneous testicular parenchyma or contour abnormality of testis in setting of scrotal trauma
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Disruption of tunica albuginea very specific for testicular rupture
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Extratesticular hematocele: Most common finding in scrotum after blunt injury
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US appearance of hematoma depends on time elapsed since trauma
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Intra- or extratesticular air in scrotum, missile track &/or foreign bodies (bullet/pellet) indicative of penetrating injury
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Spermatic cord hematoma appears as heterogeneous, avascular mass superior to testis
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Color Doppler useful to determine viable portions of testis
Pathology
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Sports injuries (> 50%), vehicular and ballistic trauma, and iatrogenic
Clinical Issues
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Unless repaired within 72 hours, salvage rate only 45%
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Follow-up of conservatively treated testicular hematomas essential due to increased risk of infection, which may result in orchiectomy
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Orchiectomy (total or partial) performed for nonviable testis in testicular rupture
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Surgical exploration and drainage must be performed for large, intratesticular hematomas
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Tumors may be discovered after trauma; consider tumor if internal color flow in intratesticular lesion
Scanning Tips
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Focal disruption of tunica albuginea = testicular rupture in setting of trauma
in the scrotal cavity. The patient was status post recent vasectomy with new-onset scrotal swelling. Testis 
is normal.
