Pediatric Testicle Trauma

  • Etiology: Sports injury most commonly followed by motor vehicle collision
  • Imaging US:
    — Ranges from contusion to testicular or epididymal hemorrhage to testicular fracture to testicular rupture
    — Scrotal wall thickening and hematocele are associated findings
  • Imaging US testicular fracture:
    — Intratesticular hypoechoic areas due to parenchymal defect leads to hematoma leads to infarction
    — Discontinuity of tunica albuginea
    — Alteration in testicular echogenicity
    — Irregular testicular contour
    — Disruption of tunica albuginea or absent flow is an indication for surgery
  • Imaging US testicular rupture:
    — Disruption or discontinuity of echogenic tunica albuginea (when two parallel hyperechoic layers outlining testis are no longer continuous) leads to testicular content extrusion
    — Irregular shape of testis
    — Scrotal hematoma
    — High salvage rate if surgery is timely
  • DDX:
  • Complications: Loss of testicle
  • Treatment: Testicular rupture patient needs surgery as risk of infertility due to autoantibodies
  • Clinical:
    — Third most common cause of acute scrotal pain
    — 10-30 years is peak age
    — Pain and swelling makes physical exam difficult therefore imaging is key
    — Testicular rupture is uncommon injury because testes and scrotum are mobile

Radiology Cases of Testicle Trauma

Radiology Cases of Testicular Contusion

CT of testicular hematoma
Axial CT with contrast of the abdomen (above) shows a heterogenous appearance to the enlarged right testicle which is surrounded by an edematous scrotal sac. Sagittal US of the right scrotum (below) again shows the thickened edematous scrotal sac, the heterogenous testicle, and an anechoic fluid collection surrounding the testicle.

Radiology Cases of Testicular Hematocele

US of testicular hematocele
Sagittal US of the left testicle (above) shows the left testicle to be intact, however the transverse US (below) shows the left testicle surrounded by an echogenic fluid collection.
US of testicular hematocele
Transverse US of the scrotum (above) shows the right scrotum to be larger in size than the left scrotum. Transverse (below left) and sagittal (below right) US of the right scrotum shows the right testicle to be intact, however it is surrounded by a complex septated fluid collection.

Radiology Cases of Testicular Hematocele and Testicular Microlithiasis

US of pediatric traumatic hematocele and testicular microlithiasis
Transverse (above left) and sagittal (above right) US of the left scrotum show the left testicle to be surrounded by a fluid collection. Magnified sagittal US of the left scrotum (below left) shows the fluid collection surrounding the left testicle to be complex in nature. The left testicle was intact. Sagittal US of the right scrotum (below right) shows no fluid around the right testicle. There are multiple punctate calcifications throughout the testicles bilaterally.