Testicular Trauma
Blunt scrotal trauma is assessed with ultrasound — loss of testicular contour or a heterogeneous testis suggests tunica albuginea rupture, which needs prompt scrotal exploration and repair to salvage the testis.
The big picture
Most testicular trauma is blunt (sports, assault, straddle). The key injury is rupture of the tunica albuginea, which allows extrusion of seminiferous tubules and forms a haematoma. Ultrasound assesses testicular integrity and blood flow.
Loss of contour or heterogeneous testis on ultrasound = suspected rupture = prompt scrotal exploration; early surgery saves testes.
Red flags
Suspected tunica rupture — explore promptly to salvage.
Ischaemia/torsion — urgent exploration.
Consider an underlying tumour — investigate with markers/imaging.
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Explore and repair suspected rupture promptly to maximise salvage; manage minor injuries conservatively.
Complications
- Testicular rupture/loss
- Haematocele, infection
- Atrophy and subfertility
- Wound infection, haematoma
- Orchidectomy if salvage fails
- Early exploration of suspected rupture
- Adequate haematoma evacuation
- Re-explore/drain; treat infection
If treatment fails
If the testis becomes non-viable or the haematoma persists, ask: was rupture under-treated, is there ongoing ischaemia, or is there infection?
Memory hooks
Blunt trauma → scrotal ultrasound.
Lost contour / heterogeneous = rupture.
Explore early to salvage.
Always think torsion too.
Board traps
Heterogeneous testis with loss of contour → explore (rupture), don't observe.
Absent flow after trauma → ischaemia/torsion, explore.
Assuming all post-traumatic masses are haematoma.
Clinical cases
A footballer sustains a direct blow to the scrotum, with severe pain and swelling. Ultrasound shows a heterogeneous testicular echotexture with loss of the normal contour.
What does the ultrasound suggest and what is the management?