Left testicular trauma with hematoma

Case contributed by Dr Dayu Gai


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.

Patient Data

Age: 20 years
Gender: Male
  1. Traumatic injury to the left testis with incomplete delineation of the tunica is concerning for rupture. Large surrounding hematoma.
  2. Echogenic foci in the right testis are of uncertain significance and may be unrelated to acute trauma.

Case Discussion

Testicular rupture is a type of testicular injury which includes testicular fracture, intratesticular hematoma, 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 hematoma 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 morbidities such as testicular atrophy and infertility 3.

Case contributed by A/Prof. Pramit Phal.

PlayAdd to Share

Case information

rID: 31696
Published: 28th Feb 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included