Imaging Scrotal Trauma

Scrotal injuries may result from either blunt or penetrating traumas. The former usually require immediate surgical exploration, while management of the latter is more complex. If the tunica albuginea is intact the lesion can be usually managed conservatively, while immediate operation is necessary if albugineal disruption is suspected. Ultrasound is the first-line imaging modality to assess testis integrity. Contour irregularity and discontinuity of the tunica albuginea are signs of testicular rupture. Color Doppler interrogation allows direct evaluation of testicular perfusion and detection of ischemic changes following contusion, or posttraumatic torsion. Besides post-traumatic epididymitis, which is assessed effectively at color Doppler interrogation, sensitivity of ultrasound in assessment of epididymal injuries is poor. Hematomas and other fluid collections present different echotexture with time. They are hyperechoic first, and then isoechoic, with mixed echogenicity, and eventually hypoechoic. Other traumatic lesions to the scrotum in which imaging has a role are testicular dislocation, vascular lesions, and hematoceles. Due to its excellent contrast resolution, wider panoramicity, and possibility to characterize blood products, MR imaging is an accurate diagnostic adjunct in those patients for whom the findings from clinical and ultrasound evaluations are inconclusive.