Emergency of acute scrotal trauma ultrasound

Abstract

Objectives • To understand scrotal anatomy, physiology and pathology. • To become familiar with the ultrasound features of benign and malignant male scrotum conditions, diagnostic pitfalls and optimizing techniques. • To present a spectrum of scrotal pathologic cases. Methods Ultrasound is the first line modality to assess the acute and chronic disease of the scrotum especially in emergency trauma cases. High frequency linear transducers are easily used to obtain high resolution ultrasonography of the scrotum. Results We review the imaging and pathologic features of a spectrum of benign and malignant processes involving the scrotum in trauma cases. The most common clinical scenario is acute scrotal pain and swelling after trauma injury in emergency cases. The scrotal injuries are categorised into extratesticular injuries and intratesticular injuries. The extratesticular injuries includes scrotal wall hematoma, hydrococele, hematocele and epididymal injuries. The intratesicular injuries includes intratesicular hematoma, testicular fracture and testicular rupture. The extratesticular injuries are usually required conservative management and the extratesticular injuries are usually required surgical treatment. The benign palpable lumps such as epididymitis, epididymo-orchitis, epididymal cyst, epidermoid cyst, spermatocele, varicocele are also commonly seen in acute settings as well. Conclusions Ultrasound provides useful clinical information in ascertaining the type of the scrotal injuries, its vascular supply and the relationship with the surrounding structures. It is fast and reliable in evaluating various extratesticular and intratesticular injuries. The knowledge and experience of the operator is crucial in making the accurate diagnosis by overcoming the potential diagnostic pitfalls and optimising techniques. This enables the clinician in planning and optimising the appropriate therapy.