Testicular trauma
Background
Scrotal anatomy
Scrotal anatomy
Testicular anatomy
1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens)
Clinical Features
- Blunt trauma due to impingement against symphysis pubis
- Will have contusion or rupture based on whether tunica albuginea is disrupted
- Large, blue, tender scrotal mass (hematocele)
- Testicular dislocation
- Absent testicle
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
- Scrotal ultrasound required for all blunt testicular injuries
- Reliable in diagnosing ruptured testes[1]
Management
- Most testicular injuries are managed conservatively
- Analgesia, ice, elevation, scrotal support, urology follow up
- Consult Urology for urgent operative care
- Testicular rupture
- Testicular dislocation (absence)
Disposition
- See above. Depends on underlying diagnosis identified.
See Also
References
- Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol 2006;175:175-8.
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