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.
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- Traumatic injury to the left testis with incomplete delineation of the tunica is concerning for rupture. Large surrounding hematoma.
- Echogenic foci in the right testis are of uncertain significance and may be unrelated to acute trauma.
1 case question available
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.
- 1. Mulhall JP, Gabram SG, Jacobs LM. Emergency management of blunt testicular trauma. Acad Emerg Med. 1996;2 (7): 639-43. Pubmed citation
- 2. Lynch TH, Martínez-Piñeiro L, Plas E et-al. EAU guidelines on urological trauma. Eur. Urol. 2005;47 (1): 1-15. doi:10.1016/j.eururo.2004.07.028 - Pubmed citation
- 3. Guichard G, El Ammari J, Del Coro C et-al. Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology. 2008;71 (1): 52-6. doi:10.1016/j.urology.2007.09.014 - Pubmed citation