Scrotal Trauma

KEY FACTS

Imaging

  • Heterogeneous testicular parenchyma or contour abnormality of testis in setting of scrotal trauma

    • Disruption of tunica albuginea very specific for testicular rupture

  • Extratesticular hematocele: Most common finding in scrotum after blunt injury

  • US appearance of hematoma depends on time elapsed since trauma

  • Intra- or extratesticular air in scrotum, missile track &/or foreign bodies (bullet/pellet) indicative of penetrating injury

  • Spermatic cord hematoma appears as heterogeneous, avascular mass superior to testis

  • Color Doppler useful to determine viable portions of testis

Pathology

  • Sports injuries (> 50%), vehicular and ballistic trauma, and iatrogenic

Clinical Issues

  • Unless repaired within 72 hours, salvage rate only 45%

  • Follow-up of conservatively treated testicular hematomas essential due to increased risk of infection, which may result in orchiectomy

  • Orchiectomy (total or partial) performed for nonviable testis in testicular rupture

  • Surgical exploration and drainage must be performed for large, intratesticular hematomas

  • Tumors may be discovered after trauma; consider tumor if internal color flow in intratesticular lesion

Scanning Tips

  • Focal disruption of tunica albuginea = testicular rupture in setting of trauma

Transverse color Doppler ultrasound of the scrotum demonstrates 2 large, extratesticular, avascular fluid collections (hematomas) in the scrotal cavity. The patient was status post recent vasectomy with new-onset scrotal swelling. Testis is normal.
Nov 10, 2024 | Posted by in ULTRASONOGRAPHY | Comments Off on Scrotal Trauma

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