Various forms of blunt, penetrating, or degloving testicular injury are recognized in the literature. Sports-related trauma and motor vehicle accidents are the two most common modes, and in the majority of cases, unilateral scrotal pain is the main clinical presentation. The diagnosis is made after conducting a detailed patient history and a physical examination, followed by ultrasonography of the testes.
Despite the fact that testicular injuries comprise less than 1% of all trauma-related injuries, early recognition of this condition is vital in order to reduce potential complications . The most common, and often the only symptom of testicular injury, is a scrotal pain, which may be sometimes accompanied by swelling, and appears after one of the recognized forms of trauma      :
Regardless of the mode of trauma, hematomas, hydroceles, hematoceles, testicular fractures, dislocation, torsion and even testicular rupture in rare cases may be seen  . Moreover, subsequent infection (epididymis and epididymo-orchitis) is a known complication, while up to 15% of testicular tumors are incidentally discovered during evaluation of testicular injury . Additional injuries of the genitalia (the urethra and the penis) are often concomitantly present with symptoms of hematuria, penile swelling and ecchymoses  . For this reason, a comprehensive workup is necessary.
Having in mind the numerous types of injuries that stem from testicular trauma, a rapid but thorough diagnostic workup is necessary. A detailed patient history needs to be conducted, during which the mode of injury and the presence of symptoms are assessed, and together with a careful physical examination (since patients experience profound discomfort due to pain) that will confirm testicular involvement, a presumptive diagnosis can be made  . However, imaging studies are mandatory for determination of the exact type of injury and selection of appropriate therapy. Currently, ultrasonography (US), both standard and color doppler, are considered as the gold standard    . Focal, or sometimes multifocal hyperechoic lesions suggest acute bleeding, anechoic fluid collections point to hydroceles, whereas a linear hypoechoic band is a hallmark of a testicular fracture  . In addition, hemorrhage and extrusion of testes into the scrotal sac are highly indicative of a testicular rupture, and a range of other findings on ultrasonography can be encountered, further strengthening its role in the diagnosis of testicular injury  . In rare cases of testicular dislocation, but also in polytraumatic patients, computed tomography (CT) of the perineum and lower abdomen is highly useful to identify the location of the testicle and assess additional organ trauma .