Testicular trauma
Last revised by Mostafa Elfeky on 13 Jan 2024
Citation, DOI, disclosures and article data
Citation:
Chen T, Elfeky M, Murphy A, et al. Testicular trauma. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-30587
Permalink:
rID:
30587
Article created:
20 Aug 2014,
Tony Chen
Disclosures:
At the time the article was created Tony Chen had no recorded disclosures.
View Tony Chen's current disclosures
Last revised:
13 Jan 2024,
Mostafa Elfeky ◉
Disclosures:
At the time the article was last revised Mostafa Elfeky had no financial relationships to ineligible companies to disclose.
View Mostafa Elfeky's current disclosures
Revisions:
24 times, by
14 contributors -
see full revision history and disclosures
Systems:
Synonyms:
- Testicular rupture
Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degrees of damage to the testes.
On this page:
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
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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.
Quiz questions
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References
- 1. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28 (6): 1617-29. Radiographics (full text) - doi:10.1148/rg.286085507 - Pubmed citation
- 2. Deurdulian C, Mittelstaedt CA, Chong WK et-al. US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics. 2007;27 (2): 357-69. doi:10.1148/rg.272065117 - Pubmed citation
- 3. Rao MS, Arjun K. Sonography of scrotal trauma. Indian J Radiol Imaging. 2012;22 (4): 293-7. doi:10.4103/0971-3026.111482 - Free text at pubmed - Pubmed citation
- 4. Marc Lucky, Gareth Brown, Trevor Dorkin, Richard Pearcy, Majid Shabbir, Chitranjan J. Shukla, Rowland W. Rees, Duncan J. Summerton, Asif Muneer. British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies ‐ testicular trauma. (2018) BJU International. 121 (6): 840. doi:10.1111/bju.14163 - Pubmed
Incoming Links
Articles:
- Testicular abscess
- Testicular torsion-detorsion syndrome
- Intratesticular haematoma
- Hydrocele
- Heterogeneous testicular echotexture
- Burned-out testis tumour
- Urogenital curriculum
- Haematospermia
- Testicular lymphoma
- Abnormal testicular Doppler flow (differential)
- Fournier gangrene
- Trauma
- Testicular seminoma
- Sports injuries - cricket
- Scrotal pyocele
- Testicular fracture
- Global testicular infarction
- Scrotal haematocele
- Testicular torsion
- RANZCR key conditions assessment
Cases:
Multiple choice questions:
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