eMedicine Specialties > Radiology > Genitourinary

Testicle, Trauma: Imaging

Author: Vikram S Dogra, MD, Professor of Diagnostic Radiology, Urology, and Biomedical Engineering, University of Rochester School of Medicine; Director, Division of Ultrasound, Associate Chair of Education and Research, Department of Imaging Sciences, University of Rochester Medical Center
Contributor Information and Disclosures

Updated: Nov 16, 2009

Radiography

Findings

Radiographs are used to detect other associated injuries.

Computed Tomography

Findings

CT is used to detect other associated injuries in patients involved in motor vehicle accidents.14

Magnetic Resonance Imaging

According to Parenti et al, color Doppler ultrasonography (CDUS) is irreplaceable as the initial approach for scrotal disease and trauma, but MRI is an ideal second-line modality. The authors followed 801 patients between 2000 and 2007 with scrotal disease or trauma who underwent CDUS, followed by MRI in 46 of the patients. CDUS revealed an inflammatory process in 277 patients, testicular trauma in 112, funicular torsion or torsion of the vestigial remnant in 44, and testicular neoplasm findings in 35. MRI identified 3 intraparenchymal hematomas, 1 intrascrotal cavernous body rupture, 1 testicular abscess with intrascrotal fistula, 2 testicular infarctions, and 15 neoplasms. MRI excluded focal abnormalities in 10 patients with testicular microlithiasis, in 3 with chronic orchitis, and in 4 with atrophic involution. MRI confirmed the finding of inguinal hernia in 3 cases. The authors concluded that MRI offers useful, occasionally decisive, information because of its abilitytoidentifyunexpectedfindings.3

Kim et al explained that because of its high soft-tissue contrast and its multiplanar capability, MRI can be a useful alternative diagnostic modality for blunt scrotal trauma, especially when ultrasonography results in an inconclusive diagnosis. In 7 patients with blunt scrotal trauma, the diagnostic accuracy of MRI was 100%. Three cases with testicular rupture were diagnosed accurately, with interruption of the dark signal intensity line of the tunica albuginea being pathognomonic for the diagnosis of testicular rupture. Two cases in which there was an inconclusive diagnosis by ultrasonography, diagnoses of epididymal hematomas were correctly made by MRI. The remaining 2 cases showed concordant results with the surgical findings.4

Ultrasonography


Longitudinal sonogram of the left testis reveals ...

Longitudinal sonogram of the left testis reveals multiple hypoechoic areas in the inferior pole, consistent with the contusion injury, secondary to gunshot wound.

[ CLOSE WINDOW ]
Longitudinal sonogram of the left testis reveals ...

Longitudinal sonogram of the left testis reveals multiple hypoechoic areas in the inferior pole, consistent with the contusion injury, secondary to gunshot wound.


Transverse sonogram of both testes demonstrates v...

Transverse sonogram of both testes demonstrates variable echo texture in the scrotal wall secondary to hemorrhage resulting from a motor vehicle accident.

[ CLOSE WINDOW ]
Transverse sonogram of both testes demonstrates v...

Transverse sonogram of both testes demonstrates variable echo texture in the scrotal wall secondary to hemorrhage resulting from a motor vehicle accident.


Findings

  • Direct visualization of a testicular fracture line is rare and observed only in approximately 17% of patients.
  • Demonstration of disruption of the tunica vasculosa is diagnostic of testicular rupture.
  • Other US findings include scrotal wall thickening, hematocele, and testicular hematoma.
  • US appearance of a hematocele varies depending on the length of time since trauma occurred.
  • Acute hematoceles are echogenic, and subacute and chronic hematoceles appear as fluid collections and may have fluid-fluid levels or low-level internal echoes. Hematocele is the most common finding.
  • In one study of 19 patients that evaluated US features of scrotal injuries caused by gunshot wounds, testicular rupture was detected sonographically in 6 patients.
  • US in patients with surgically confirmed testicular rupture revealed heterogeneous echogenicity and loss of smooth oval contour.

Degree of Confidence

US is the modality of choice for imaging. US has 100% sensitivity and 80% specificity for testicular trauma.

False Positives/Negatives

Hemorrhage from underlying tumor or incarcerated hernia may cause a false-positive diagnosis.

More on Testicle, Trauma

Overview: Testicle, Trauma
Imaging: Testicle, Trauma
Follow-up: Testicle, Trauma
Multimedia: Testicle, Trauma
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Adams RJ, Attia M, Cronan K. Report of 4 cases of testicular rupture in adolescent boys secondary to sports-related trauma. Pediatr Emerg Care. Dec 2008;24(12):847-8. [Medline].

  2. Okonkwo KC, Wong KG, Cho CT, Gilmer L. Testicular trauma resulting in shock and systemic inflammatory response syndrome: a case report. Cases J. May 12 2008;1(1):4. [Medline].

  3. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. Mar 2004;42(2):349-63. [Medline].

  4. Dogra VS, Bhatt S. Categorical Course in Diagnostic Radiology: Acute Scrotal Pain: Imaging Evaluation for a More Specific Diagnosis. Ramchandani P, ed. Oak Brook, Ill; Radiological Society of North America: Genitourinary Radiology;. 2006: 255-70.

  5. Dogra VS, Gottlieb RH, Oka M. Sonography of the scrotum. Radiology. Apr 2003;227(1):18-36.

  6. Parenti GC, Feletti F, Brandini F, Palmarini D, Zago S, Ginevra A, et al. Imaging of the scrotum: role of MRI. Radiol Med. Apr 2009;114(3):414-24. [Medline].

  7. Kim SH, Park S, Choi SH, Jeong WK, Choi JH. The efficacy of magnetic resonance imaging for the diagnosis of testicular rupture: a prospective preliminary study. J Trauma. Jan 2009;66(1):239-42. [Medline].

  8. Phonsombat S, Master VA, McAninch JW. Penetrating external genital trauma: a 30-year single institution experience. J Urol. Jul 2008;180(1):192-5; discussion 195-6. [Medline].

  9. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. Oct 2008;28(6):1617-29. [Medline].

  10. Cassar S, Bhatt S, Paltiel HJ, Dogra VS. Role of spectral Doppler sonography in the evaluation of partial testicular torsion. J Ultrasound Med. Nov 2008;27(11):1629-38. [Medline].

  11. Lee JC, Bhatt S, Dogra VS. Imaging of the epididymis. Ultrasound Q. Mar 2008;24(1):3-16. [Medline].

  12. Bonkat G, Ruszat R, Forster T, Wyler S, Dogra VS, Bachmann A. [Benign space-occupying cysts in the testis. An overview]. Urologe A. Dec 2007;46(12):1697-703. [Medline].

  13. Lin EP, Bhatt S, Rubens DJ, Dogra VS. Testicular torsion: twists and turns. Semin Ultrasound CT MR. Aug 2007;28(4):317-28. [Medline].

  14. Ezra N, Afari A, Wong J. Pelvic and scrotal trauma: CT and triage of patients. Abdom Imaging. Jul 2009;34(4):541-4. [Medline].

  15. Anderson KA, McAninch JW, Jeffrey RB. Ultrasonography for the diagnosis and staging of blunt scrotal trauma. J Urol. Nov 1983;130(5):933-5. [Medline].

  16. Bhandary P, Abbitt PL, Watson L. Ultrasound diagnosis of traumatic testicular rupture. J Clin Ultrasound. Jun 1992;20(5):346-8. [Medline].

  17. Cass AS, Luxenberg M. Testicular injuries. Urology. Jun 1991;37(6):528-30. [Medline].

  18. Haas CA, Brown SL, Spirnak JP. Penile fracture and testicular rupture. World J Urol. Apr 1999;17(2):101-6. [Medline].

  19. Herbener TE. Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound. Oct 1996;24(8):405-21. [Medline].

  20. Learch TJ, Hansch LP, Ralls PW. Sonography in patients with gunshot wounds of the scrotum: imaging findings and their value. AJR Am J Roentgenol. Oct 1995;165(4):879-83. [Medline].

  21. McAninch JW, Kahn RI, Jeffrey RB. Major traumatic and septic genital injuries. J Trauma. Apr 1984;24(4):291-8. [Medline].

  22. Sasso F, Gulino G, Di Pinto A. [Correlation between ultrasonography imaging and surgical findings in scrotal trauma]. Arch Ital Urol Androl. Apr 1995;67(2):159-62. [Medline].

  23. Schuster G. Traumatic rupture of the testicle and a review of the literature. J Urol. Jun 1982;127(6):1194-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics

 Testicular Trauma

Testicular Torsion (Emergency Medicine)

Testicular Torsion  (Radiology)

Scrotal Trauma


 

[ CLOSE WINDOW ]

Keywords

testicular trauma, testicular fracture, testicular rupture, testicular contusion, testicular hematoma, celomic, coelomic

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Vikram S Dogra, MD, Professor of Diagnostic Radiology, Urology, and Biomedical Engineering, University of Rochester School of Medicine; Director, Division of Ultrasound, Associate Chair of Education and Research, Department of Imaging Sciences, University of Rochester Medical Center
Vikram S Dogra, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of Program Directors in Radiology, Radiological Society of North America, Society of Radiologists in Ultrasound, and Society of Uroradiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Matthew D Rifkin, MD, Director, Department of Radiology, Good Samaritan Hospital
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.