Left testicular trauma with hematoma

This patient was riding his motorbike, when a car crossed in front of him at speed. He had no recollection of events after this, however described severe pain in his scrotum. Ultrasound studies of the testicle are shown below.

Testicular rupture is a type of testicular injury which includes testicular fracture, intratesticular haematoma, testicular avulsion and epididymal injuries. Testicular rupture occurs when there is a fracture of the tunica albuginea with extrusion of the seminiferous tissue outside the capsule ¹.

Ultrasound is the preferred initial investigation for diagnosis of testicular rupture. Surgical exploration is often indicated as well. Findings consistent with testicular rupture include ³:

• hypoechogenic and heterogeneous parenchyma
• loss of contour definition
• tunica albuginea breach

In this patient's case, there is a large haematoma surrounding the testicle. There is decreased vascularity. The testicle does not appear heterogeneous.

Management of testicular rupture mandates surgical exploration with excision of necrotic testicular tubules and closure of the tunica albuginea ². Early surgical exploration is recommended over conservative management due to the significantly higher rates of orchiectomy in delayed surgery.

Complications of poorly managed testicular trauma include the necessity for orchiectomy and other morbidity such as testicular atrophy and infertility ³.

Case contributed by A/Prof. Pramit Phal.