You are in: eMedicine Specialties > Radiology > GENITOURINARY Testicle, TraumaArticle Last Updated: Dec 21, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Vikram S Dogra, MD, Professor of Diagnostic Radiology, University of Rochester School of Medicine; Director, Division of Ultrasound, Associate Chair of Education and Research, Department of Imaging Sciences, University of Rochester Medical Center Vikram S Dogra is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of Program Directors in Radiology, Radiological Society of North America, Society of Radiologists in Ultrasound, and Society of Uroradiology Editors: Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand; Matthew D Rifkin, MD, Director, Department of Radiology, Good Samaritan Hospital; Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute; Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center Author and Editor Disclosure Synonyms and related keywords: testicular fracture, testicular rupture, testicular contusion, testicular hematoma, celomic, coelomic INTRODUCTIONSection 2 of 9
  BackgroundTesticular trauma is uncommon because of its anatomic location and the mobility of testes within the scrotum. Most testicular trauma occurrences are related to sports injuries. Other causes include direct trauma, motor vehicle accidents, and straddle injuries. Patients present with an acute scrotum and history of trauma. Diagnosis is made in combination with clinical history and physical and ultrasound (US) findings. Testicular rupture is a urologic emergency, and more than 80% of ruptured testes can be saved if surgery is performed within 72 hours. PathophysiologyTrauma to a testis is uncommon because of its mobility and position. Trauma can be penetrating or blunt (more common). Impingement of the testis against the symphysis pubis or ischial ramus is the most common mechanism of injury resulting from blunt trauma. FrequencyUnited StatesMore than 50% of testicular ruptures occur during sporting events. Motor vehicle accidents account for 9-17% of testicular injuries. InternationalThe international incidence is the same as in the US. Mortality/MorbidityTesticular rupture is a urologic emergency, and more than 80% of ruptured testes can be saved if surgery is performed within 72 hours. SexThe condition is observed only in men. AgeThe age at which testicular trauma occurs most commonly is 16-20 years; however, it can occur at any age. AnatomyA normal testis develops in the celomic cavity and begins to descend into the scrotum at 36 weeks, guided by the contractile cordlike structure termed the gubernaculum testis. Testicular size depends on age and stage of sexual development. Before age 12 years, testicular volume is 1-2 mL. Mean testicular volume at 16 years is 14 mL. Prepubertal testes are of low-to-medium level echogenicity. US is the most common imaging study used to evaluate the testes. On US, a normal adult testis has medium-level echoes and measures approximately 5 X 3 X 2 cm. The tunica albuginea is the fibrous covering of the testicle. Capsular arteries (division of testicular artery) run under the tunica albuginea, forming the tunica vasculosa. Septa extend from the tunica albuginea into the testicle, dividing the testes into lobules. The posterior surface of the tunica albuginea is reflected into the interior of the gland, forming the incomplete septum termed the mediastinum of the testis. Sonographically, this appears as an echogenic band running across the testis. Each lobule is composed of multiple seminiferous tubules that open via tubules (tubuli recti) into dilated spaces termed the rete testes within the mediastinum. These in turn communicate via efferent ductules in the epididymal head. The epididymis is composed of a head, body, and tail, the ducts of which continue as the vas deferens in the spermatic cord. Clinical DetailsPatients present with symptoms of an acute scrotum and history of trauma. Physical examination reveals scrotal edema and ecchymosis of the scrotal skin. The scrotum is tender to the touch, and discrete testis may be difficult to palpate because of surrounding edema and/or hematoma. Preferred ExaminationUS is the imaging modality of choice. If US fails to reveal contusion, hematoma, or testicular rupture, perform surgical exploration. Limitations of TechniquesUS detects testicular contusion, hematoma, or rupture well. US is 80% specific for detecting tunica albuginea fracture. DIFFERENTIALSSection 3 of 9
Epididymitis Testicle, Malignant Tumors Testicle, Trauma Testicular Torsion
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| Media file 1: Longitudinal sonogram of the left testis reveals multiple hypoechoic areas in the inferior pole, consistent with the contusion injury, secondary to gunshot wound. | |
 | View Full Size Image | Media type: X-RAY |
| Media file 2: Transverse sonogram of both testes demonstrates variable echo texture in the scrotal wall secondary to hemorrhage resulting from a motor vehicle accident. | |
 | View Full Size Image | Media type: CT |
Article Last Updated: Dec 21, 2006
