Testicular trauma

Last revised by Andrew Murphy on 31 Jul 2022

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

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

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

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

  • 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
  • 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

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

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Cases and figures

  • Case 1: intra-testicular hematoma
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  • Case 2
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  • Case 3: traumatic testicular rupture
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  • Case 4: testicular rupture
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  • Case 5: testicular rupture with hematocele
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  • Case 6: rupture, contusion and hematocele
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