History
Acute scrotal pain, swelling, bruising, and any associated skin loss from injury are the primary clinical findings. Even in isolated injuries, abdominal pain, nausea, emesis, and difficulty with voiding may occur. Embarrassment associated with the site, mechanism, or circumstance of injury often results in delayed presentation and may complicate diagnostic evaluation.
Physical Examination
Physical examination includes a general survey, with particular attention to abdominal and pelvic injuries and areas of bruising inferior to the area caudal to the anterior superior iliac spine.
Penile examination should assess corporal integrity and should include inspection of the urethral meatus for blood that may indicate urethral injury.
Scrotal examination must document all of the following elements:
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Location of swelling
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Skin ecchymosis - Extent and location
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Skin loss - Percent and integrity of remaining tunics
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Exit and entry wounds
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Testes/epididymides - Location, integrity, pain to palpation, and response to cremasteric reflex (stroking inner thigh)
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Transillumination in instances without hematocele in which the testis is impalpable
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Assessment for inguinal herniae
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Transverse scrotal ultrasound image shows left intratesticular hematoma and hematocele consistent with testis rupture. Increased testis size on left is a soft sign, as hematoma alone could result in this finding.
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Longitudinal image of left testis showing discontinuity of tunica albuginea. This finding mandates scrotal exploration.
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This longitudinal Doppler image shows perfused testicular tissue exuding through disrupted tunica albuginea, eliminating any doubt regarding the diagnosis of testicular rupture.
