Hodentrauma

Acute scrotal
ultrasound: a practical guide. Scrotal trauma. a Testicular rupture. Longitudinal US of the right testis in a 19-year-old male following jet ski accident. There is disruption of the tunica albuginea (arrowheads) and extrusion of a large amount of the inferior pole of the testis (annotated by letter E); the normal tunica albuginea is noted more superiorly (arrow). Also note surrounding hematocele (asterisk). The patient underwent debridement and repair with preservation of the superior aspect of the right testis. b Testicular fracture. Longitudinal US of the left testis in a 47-year-old who sustained a traumatic scrotal injury after being struck by a baseball traveling at high velocity. The thin hypoechoic band (arrows) corresponds to the testicular fracture line. Orchiectomy was performed due to extent of injury. c Penetrating testicular trauma with intrascrotal gas. Transverse US of the left testis in a 25-year-old who sustained a traumatic scrotal injury after a hand gun discharged while in the patient’s pants pocket. A focal defect (arrow) along the lateral aspect of the left testis corresponds to a site of tunica albuginea rupture and tubule extrusion. A cluster of amorphous echogenic foci with mild posterior shadowing in the testicular parenchyma are due to intratesticular gas. The patient was treated with orchiectomy
theultrasoundjournal.springeropen.com • CC-by-2.0
Teenager
kicked in the left scrotum. 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.The diagnosis was testicular hematocele.
pediatricimaging.org • CC-by-nc-sa 4.0
Male toddler
with a swollen right scrotum after having been taken cross country skiing in their parents baby backpack. 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.The diagnosis was testicular hematocele.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degrees of damage to the testes.

Pathology

Testicular rupture and testicular ischemia/infarct are two severe complications which need to be ruled out. Other injuries that can occur include :

Etiology

Testicular trauma can be blunt or penetrating in cause. Also, iatrogenic injury from surgery (e.g. incorrect site, inguinoscrotal surgery) can occur .

Associations

Associated extratesticular injuries (e.g. epididymis fracture, epididymitis, scrotal wall hematoma, haematoceles) can also commonly occur .

Radiographic features

Ultrasound
Testicular rupture
  • haematocele is usually present
  • assess for disruption of the tunica albuginea, which is normally a smooth echogenic line
    • signs of disruption include loss of continuity, crinkling, or retraction
  • extrusion of the seminiferous tubules can occur (and may mimic a complex haematocele)
    • assess with Doppler as seminiferous tubules should retain arterial blood supply to differentiate between this and a complex haematocele
Testicular ischemia/infarct
  • a heterogenous testis suggests patchy testicular ischemia or infarct
  • ultrasound imaging features are similar to testicular torsion but the pathogenesis is different; post-traumatic infarct is due to increased intra-testicular pressure resulting in venous obstruction and venous infarction

Treatment and prognosis

Surgical management is required for testicular rupture and large haematoceles. Penetrating scrotal trauma will also typically require surgery. Small testicular hematomas may be managed conservatively .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Hodentrauma:
skrotales
Trauma
Wikipedia • CC0
testicular
hematoma
pediatricimaging.org • CC-by-nc-sa 4.0
akutes
Skrotum
Wikipedia • CC BY 3.0