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US of Acute Scrotal Trauma: Optimal Technique, Imaging Findings, and Management¹

¹ From the Department of Imaging, W.G. "Bill" Hefner V.A. Medical Center, 1601 Brenner Ave, Salisbury, NC 28144 (C.D.); and Abdominal Imaging Section, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (C.A.M., W.K.C., J.R.F.). Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received June 7, 2006; revision requested June 30 and received September 14; accepted September 26. All authors have no financial relationships to disclose. Address correspondence to C.D. (e-mail: drcorinne{at}hotmail.com).

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.

© RSNA, 2007

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