Testicular trauma

Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degrees of damage to the testes.

Pathology

Testicular rupture and testicular ischemia/infarct are two severe complications which need to be ruled out. Other injuries that can occur include ¹:

• testicular fracture
• testicular dislocation
• testicular torsion
• intratesticular hematoma
• intratesticular pseudoaneurysm

Etiology

Testicular trauma can be blunt or penetrating in cause. Also, iatrogenic injury from surgery (e.g. incorrect site, inguinoscrotal surgery) can occur ⁴.

Associations

Associated extratesticular injuries (e.g. epididymis fracture, epididymitis, scrotal wall hematoma, hematoceles) can also commonly occur ³. 

Radiographic features

Ultrasound

Testicular rupture

• hematocele is usually present
• assess for disruption of the tunica albuginea, which is normally a smooth echogenic line
  • signs of disruption include loss of continuity, crinkling, or retraction
• extrusion of the seminiferous tubules can occur (and may mimic a complex hematocele)
  • assess with Doppler as seminiferous tubules should retain arterial blood supply to differentiate between this and a complex hematocele

Testicular ischemia/infarct

• a heterogenous testis suggests patchy testicular ischemia or infarct
• ultrasound imaging features are similar to testicular torsion but the pathogenesis is different; post-traumatic infarct is due to increased intra-testicular pressure resulting in venous obstruction and venous infarction

Treatment and prognosis

Surgical management is required for testicular rupture and large hematoceles. Penetrating scrotal trauma will also typically require surgery. Small testicular hematomas may be managed conservatively ⁴.