US of Acute Scrotal Trauma: Optimal Technique, Imaging Findings, and Management

Abstract

The primary causes of scrotal trauma are blunt, penetrating, degloving, and electrical burn injuries to scrotal contents. Knowledge of the scrotal anatomy and appropriate imaging techniques are key for accurate evaluation of scrotal injuries. Ultrasonography (US) is the first-line imaging modality to help guide therapy for scrotal trauma, except in degloving injury, which results in scrotal skin avulsion. Blunt injury (eg, from an athletic accident or motor vehicle collision) is the most common cause of scrotal trauma, followed by penetrating injury from gunshot or other assault. Trauma often may result in hematoma, hydrocele, hematocele, testicular fracture, or testicular rupture. The timely diagnosis of rupture, based on a US finding of discontinuity of the echogenic tunica albuginea, is critical because emergent surgery results in salvage of the testis in 80%-90% of rupture cases. The radiologist should be familiar also with other nuances associated with penetrating trauma, iatrogenic and postoperative complications, and electrical injury. Color flow and duplex Doppler imaging are highly useful techniques not only for assessing testicular viability and perfusion but also for evaluating associated vascular injuries such as pseudoaneurysms. A thorough familiarity with the US findings of scrotal trauma helps facilitate appropriate management. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/27/2/357/DC1.

A review of ultrasound imaging in scrotal emergencies

“…The tunica albuginea is seen on grey-scale ultrasound as an echogenic lining of the testis; the characteristic finding in testicular rupture is disruption of this lining with extrusion of the parenchyma. The testis may appear distorted in shape with variable echogenicity and varying degrees of haematoma, haemorrhage and ischaemia; there may be an associated haematocele [33].…”

“…However, these appearances are described in only 17 % [34]. Colour Doppler imaging guides management by determining the degree of ischaemic parenchyma which requires resection; however if parenchymal blood flow is preserved, conservative management can be undertaken [33]. CEUS may play a larger role in the future to determine the extent of viable testicular tissue and allow testis-conserving surgery [4].…”

“…Ultrasound appearances of haematoma and haematocele are variable and evolve with time. Initially the appearances are echogenic and gradually over time liquefy and become anechoic, often with septations before re-absorption [33]. On colour Doppler imaging there is no signal; however, it is essential to interrogate the vascularity of the testis and expedite prompt surgery in the presence of ischaemia.…”

“…8). Conservative management for scrotal haematomas less than three times the size of the contralateral testis and surgical intervention for those which are larger is generally advocated [33][34][35][36].…”

Consulta diferida de un traumatismo escrotal

“…La RM aporta una imagen clara y detallada de la anatomía y ayuda a valorar la extensió n de la lesió n, determinado por la presencia o ausencia de hemorragia intratesticular, con valor pronó stico. Esto podría reducir el nú mero de escrototomías exploradoras en el contexto del traumatismo testicular 3,4 .…”