A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma

Abstract

Genitourinary tract injuries account for 3 to 10% of trauma patients, and scrotal trauma is particularly prevalent in males 10 to 30 years of age. Prompt diagnosis and timely surgical intervention are essential to prevent future complications of infertility, delayed orchiectomy, infection, and testicular atrophy. While clinical examination provides valuable information, it may be inconclusive due to soft tissue swelling and difficult to perform due to testicular pain with palpation. Conversely, testicular rupture does not always present with pain or tenderness. Imaging can contribute additional support for surgical evaluation in scrotal trauma. Current AUA guidelines support ultrasound in blunt scrotal trauma to confirm testicular rupture while recommending early exploration in penetrating injuries due to the high incidence of testicular rupture. This review discusses the existing literature on the use of various imaging modalities in assessment of blunt and penetrating scrotal trauma and common imaging findings.

Bilateral testes fractures from blunt scrotal trauma

“…Ultrasound is often the first diagnostic tool beyond a physical exam that is used to evaluate blunt scrotal trauma given it is a non-invasive, expeditious, and essentially ubiquitous technology. Ultrasonographic findings which may help with accurate clinical diagnosis have been adapted from Wang and Fenton and are outlined in Table 1 1 , 2 . In one of the larger published series, Buckley and McAninch retrospectively reviewed 65 patients with blunt scrotal trauma over a 25 year period and found that a heterogeneous parenchymal echo pattern with loss of testicular contour is highly sensitive (100%) and specific (93.5%) for testicular rupture or testicular torsion 3 …”

Testicular Rupture Following Blunt Scrotal Trauma

“…e di erential diagnosis of scrotal injuries is myriad and includes epididymitis, orchitis, incarcerated inguinal hernia, testicular infarction, testicular fracture or rupture, testicular torsion, appendicular torsion, dislocated testes, hydrocele, or hematocele [6]. Clinical examination may be di cultpatients are o en reluctant to be examined due to pain and so tissue swelling can make the testes di cult to palpate [3].…”

“…e main goal of US is to assess the vascular perfusion and integrity of the testes and distinguish testicular rupture from other injuries. Using modern ultrasound equipment, a sensitivity, and speci city of 95-100% for diagnosing testicular rupture is now possible [6,9]. e normal tunica albuginea in US appears as a thin echogenic line surrounding the testicular parenchyma and is challenging to appreciate especially in the presence of scrotal contusion [10].…”

“…Heterogeneous parenchyma echotexture and irregular margins are typical characteristics of testicular rupture. Additional sonographic ndings include disruption of the tunica vaginalis, fracture lines through the testicle, decreased or loss of blood ow on color Doppler sonography, scrotal thickening, and hematocele formation [3,6,10]. Doppler imaging plays an important role in directing management; the presence of vascularity within the testicular parenchyma is indicative of its salvageability [3].…”

“…Doppler imaging plays an important role in directing management; the presence of vascularity within the testicular parenchyma is indicative of its salvageability [3]. Some false-negative testicular rupture cases diagnosed by US have been reported, leading to misdiagnosis, and delayed surgical intervention [6]. Other imaging studies, such as contrast-enhanced US, nuclear imaging, or magnetic resonance imaging (MRI), have been used to obtain additional information in equivocal cases [10].…”