Has Ultrasound Influenced the Therapy Concept of Blunt Scrotal Trauma?

Abstract

We present the ultrasonic diagnoses and treatment of 44 patients with blunt scrotal trauma (rupture of the testis, hematocele, intratesticular hematoma and hematoma of the scrotal layers). Purely intratesticular hematoma without any other accompanying injury also can be detected sonographically. When massive scrotal swelling is present ultrasound is valuable to determine the status of the underlying testis even if discrete fracture planes of the tunica cannot always be detected. To achieve best long-term results early surgical intervention should be performed in cases of rupture of the testicle and hematocele, while hematoma of the scrotal layers and purely intratesticular hematoma can be treated conservatively.

Significant Predictors for Determination of Testicular Rupture on Sonography

“…Contour irregularity was defined as a disruption or obliteration of the outline of the testis and subsequent extrusion of the testicular contents that resulted in the formation of an amorphous extratesticular mass connected to the testis. [3][4][5][6][7]9,13 An intratesticular heterogeneous echo was defined as the presence of a focal or diffuse hypoechoic or hyperechoic portion inside the testis. [3][4][5] An extratesticular heterogeneous echo was defined in a similar manner, but the location was outside the testis (ie, the epididymis, tunica vaginalis sac, spermatic cord, or scrotal wall).…”

“…and W.K.J.). [3][4][5][6][7]13 The observer radiologist (W.K.J.) independently viewed the sonographic images in real time.…”

Value of Testicular Ultrasound in the Evaluation of Blunt Scrotal Trauma without Haematocele

“…Surgically treated patients resume normal activities earlier than those treated conservatively, and the number of orchiectomies is lower (Cass and Luxenberg, 1988). Ultrasonography, however, plays an important role in the diagnosis of blunt scrotal trauma without haematocele (Kratzik et al, 1989).…”

Genitourinary System

“…Thus, in any patient who is being treated conservatively for testicular hematoma (Fig. 17.20 ), follow-up imaging to resolution is required in order to ensure that there is no underlying mass Kratzik et al 1989 ). When evaluating testicles, it is important to note that there are benign intratesticular structures which can lead to false-positive diagnosis of neoplasms.…”