Diagnostic Ultrasound - Abdomen and Pelvis

Scrotal Trauma
Diagnoses: Scrotum
IMAGING
• Heterogeneous testicular parenchyma or contour
abnormality of testis in setting of scrotal trauma
○ Disruption of tunica albuginea is very specific for
testicular rupture
• Extratesticular hematocele: Most common finding in
scrotum after blunt injury
• US appearance of hematoma depends on time elapsed
since trauma
• Intra- or extratesticular air in scrotum, missile track &/or
foreign bodies (bullet/pellet) is indicative of penetrating
injury
• Spermatic cord hematoma appears as heterogeneous
avascular mass superior to testis
• Color Doppler is useful to determine viable portions of
testis
KEY FACTS
PATHOLOGY
• Sports injuries (> 50%), vehicular and ballistic trauma, and
iatrogenic
CLINICAL ISSUES
• Unless repaired within 72 hours, salvage rate only 45%
• Follow-up of conservatively treated testicular hematomas is
essential due to increased risk of infection, which may result
in orchiectomy
• Orchiectomy (total or partial) is performed for nonviable
testis in testicular rupture
• Surgical exploration and drainage must be performed for
large intratesticular hematomas
• Tumors may be discovered after trauma, consider tumor if
there is internal color flow in an intratesticular lesion
(Left) Transverse color
Doppler ultrasound of the
scrotum demonstrates 2 large,
extratesticular avascular fluid
collections (hematomas) in
the scrotal cavity. The patient
was status post recent
vasectomy with new onset
scrotal swelling. Testis st is
normal. (Right) Sagittal
ultrasound of the right testis
after a MVC demonstrates
heterogeneous testicular
parenchyma with indistinct
tunica albuginea and adjacent
hematocele st. Surgery
confirmed a testicular rupture.
(Left) Sagittal grayscale
ultrasound of the right scrotal
cavity shows a large, complex
extratesticular fluid collection
, consistent with
hematocele. Mildly
heterogeneous testis st is
suggestive of
contusion/hematoma. (Right)
Color Doppler ultrasound of
the right testis shows an
avascular complex fluid
collection consistent with
an intratesticular hematoma.
The patient was continually
followed until resolution of
this hematoma.
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