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Pediatric Radiology

, Volume 46, Issue 7, pp 1049–1058 | Cite as

Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know

  • Laura Z. FentonEmail author
  • S. Pinar Karakas
  • Laurence Baskin
  • Jeffrey B. Campbell
Pictorial Essay

Abstract

Pediatric blunt scrotal trauma is most often the consequence of sports injury and presents a diagnostic challenge because swelling and pain make a scrotal physical exam difficult. US with color flow and duplex Doppler is the first-line imaging modality with the goal of accurate and timely diagnosis of injury requiring surgery to preserve fertility and hormonal function. US imaging findings following blunt scrotal trauma include hydrocele, hematocele, testicular hematoma, testicular fracture, testicular rupture, compromised perfusion/testicular torsion and testicular dislocation. Importantly, several of these findings may coexist. Our goal is to present the pertinent intrascrotal anatomy, US imaging findings for each testicular injury, and contemporary management for each, with emphasis on what our pediatric urology colleagues need to know for optimal patient care.

Keywords

Children Rupture Scrotum Testicle Torsion Trauma Ultrasound 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Munter DW, Faleski EJ (1989) Blunt scrotal trauma: emergency department evaluation and management. Am J Emerg Med 7:227–234CrossRefPubMedGoogle Scholar
  2. 2.
    Sung EK, Setty BN, Castro-Aragon I (2012) Sonography of the pediatric scrotum: emphasis on the Ts--torsion, trauma, and tumors. AJR Am J Roentgenol 198:996–1003CrossRefPubMedGoogle Scholar
  3. 3.
    Herbener TE (1996) Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound 24:405–421CrossRefPubMedGoogle Scholar
  4. 4.
    Dogra VS, Gottlieb RH, Oka M (2003) Sonography of the scrotum. Radiology 227:18–36CrossRefPubMedGoogle Scholar
  5. 5.
    Garriga V, Serrano A, Marin A et al (2009) US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. Radiographics 29:2017–2032CrossRefPubMedGoogle Scholar
  6. 6.
    Avery LL, Scheinfeld MH (2013) Imaging of penile and scrotal emergencies. Radiographics 33:721–740CrossRefPubMedGoogle Scholar
  7. 7.
    Bhatt S, Dogra VS (2008) Role of US in testicular and scrotal trauma. Radiographics 28:1617–1629CrossRefPubMedGoogle Scholar
  8. 8.
    Krone KD, Carroll BA (1985) Scrotal ultrasound. Radiol Clin North Am 23:121–139PubMedGoogle Scholar
  9. 9.
    Jeffrey RB, Laing FC, Hricak H et al (1983) Sonography of testicular trauma. AJR Am J Roentgenol 141:993–995CrossRefPubMedGoogle Scholar
  10. 10.
    Buckley JC, McAninch JW (2006) Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol 175:175–178CrossRefPubMedGoogle Scholar
  11. 11.
    Dogra VS, Rubens DJ, Gottlieb RH et al (2004) Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum. J Ultrasound Med 23:1077–1085PubMedGoogle Scholar
  12. 12.
    Deurdulian C, Mittelstaedt CA, Chong WK et al (2007) US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics 27:357–369CrossRefPubMedGoogle Scholar
  13. 13.
    Purushothaman H, Sellars ME, Clarke JL et al (2007) Intratesticular haematoma: differentiation from tumour on clinical history and ultrasound appearances in two cases. Br J Radiol 80:e184–e187CrossRefPubMedGoogle Scholar
  14. 14.
    Bhatt S, Jafri SZ, Wasserman N et al (2011) Imaging of non-neoplastic intratesticular masses. Diagn Interv Radiol 17:52–63PubMedGoogle Scholar
  15. 15.
    Gaur S, Bhatt S, Derchi L et al (2011) Spontaneous intratesticular hemorrhage: two case descriptions and brief review of the literature. J Ultrasound Med 30:101–104PubMedGoogle Scholar
  16. 16.
    Patil MG, Onuora VC (1994) The value of ultrasound in the evaluation of patients with blunt scrotal trauma. Injury 25:177–178CrossRefPubMedGoogle Scholar
  17. 17.
    Gross M (1969) Rupture of the testicle: the importance of early surgical treatment. J Urol 101:196–197PubMedGoogle Scholar
  18. 18.
    Guichard G, El Ammari J, Del Coro C et al (2008) Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology 71:52–56CrossRefPubMedGoogle Scholar
  19. 19.
    Cubillos J, Reda EF, Gitlin J et al (2010) A conservative approach to testicular rupture in adolescent boys. J Urol 184:1733–1738CrossRefPubMedGoogle Scholar
  20. 20.
    Seng YJ, Moissinac K (2000) Trauma induced testicular torsion: a reminder for the unwary. J Accid Emerg Med 17:381–382CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Elsaharty S, Pranikoff K, Magoss IV et al (1984) Traumatic torsion of the testis. J Urol 132:1155–1156PubMedGoogle Scholar
  22. 22.
    Cos LR, Rabinowitz R (1982) Trauma-induced testicular torsion in children. J Trauma 22:244–246CrossRefPubMedGoogle Scholar
  23. 23.
    Kursh ED (1981) Traumatic torsion of testicle. Urology 17:441–442CrossRefPubMedGoogle Scholar
  24. 24.
    Mikkilineni H, Karakas S (2013) Pediatric radiology. Oxford University Press, New YorkGoogle Scholar
  25. 25.
    Kaye JD, Shapiro EY, Levitt SB et al (2008) Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration. J Urol 180:1733–1736CrossRefPubMedGoogle Scholar
  26. 26.
    Liang T, Metcalfe P, Sevcik W et al (2013) Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum. AJR Am J Roentgenol 200:W444–W449CrossRefPubMedGoogle Scholar
  27. 27.
    Karmazyn B, Steinberg R, Kornreich L et al (2005) Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol 35:302–310CrossRefPubMedGoogle Scholar
  28. 28.
    Kalfa N, Veyrac C, Lopez M et al (2007) Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol 177:297–301Google Scholar
  29. 29.
    Gómez RG, Storme O, Catalán G et al (2014) Traumatic testicular dislocation. Int Urol Nephrol 46:1883–1887CrossRefPubMedGoogle Scholar
  30. 30.
    Matzek BA, Linklater DR (2013) Traumatic testicular dislocation after minor trauma in a pediatric patient. J Emerg Med 45:537–540CrossRefPubMedGoogle Scholar
  31. 31.
    Feder M, Sacchetti A, Myrick S (1991) Testicular dislocation following minor scrotal trauma. Am J Emerg Med 9:40–42CrossRefPubMedGoogle Scholar
  32. 32.
    Perera E, Bhatt S, Dogra VS (2011) Traumatic ectopic dislocation of testis. J Clin Imaging Sci 1:17PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kilian CA, Paz DA, Patel SA et al (2009) False diagnosis of ruptured testes in a case of traumatic dislocation. J Ultrasound Med 28:549–553PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Laura Z. Fenton
    • 1
    Email author
  • S. Pinar Karakas
    • 2
  • Laurence Baskin
    • 3
  • Jeffrey B. Campbell
    • 4
  1. 1.Department of Pediatric Radiology, Children’s Hospital Coloradoaffiliated with the University of Colorado School of MedicineAuroraUSA
  2. 2.Department of RadiologyUCSF Benioff Children’s HospitalOaklandUSA
  3. 3.Department of Pediatric UrologyUCSF Benioff Children’s HospitalSan FranciscoUSA
  4. 4.Department of Pediatric Urology, Children’s Hospital Coloradoaffiliated with the University of Colorado School of MedicineAuroraUSA

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