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How common are traumatic injuries to the epididymis? A study of prevalence, imaging appearance, and management implications

Abstract

Purpose

To evaluate the prevalence of epididymal injuries with scrotal trauma, review imaging appearance, clinical management, and outcomes.

Methods

In this retrospective study, the radiology report database was queried for scrotal ultrasounds containing keywords pertaining to trauma, from 1998 to 2019. Exams with no clinically documented trauma, exams with trauma > 1 year ago, and duplicate exams were excluded. Chart review was conducted for age, trauma mechanism, time interval between trauma and ultrasound, signs of infection, and clinical management. Reports were reviewed to record the presence of scrotal injury, traumatic epididymitis, or epididymal hematoma. Cases with epididymal injury underwent image review. Descriptive statistics, Fisher’s exact test, and Mann-Whitney’s U test were performed to evaluate for associations between clinical parameters and epididymal injury.

Results

Initial search yielded 385 exams. A total of 103 exams met inclusion criteria. Trauma mechanisms included straddle injury (35%), blunt scrotal trauma by ball or other object (29%), assault (28%), penetrating injury (4%), and fall (3%). Sixty-eight patients (66%) had scrotal injury on imaging. Twenty-six (25%) had epididymal injury. Thirteen were isolated to the epididymis, and 13 had associated testicular or extra-testicular findings. There were 12 cases of traumatic epididymitis and 14 epididymal hematomas. All epididymal injuries were managed non-operatively. A total of 7 were prescribed antibiotics, including 1 subject who otherwise had no evidence of infection.

Conclusion

Epididymal injury is encountered in 25% of scrotal ultrasounds for trauma evaluation. Traumatic epididymitis can be seen in 12%. It is important for radiologists to recognize this entity, as it can be mistaken for infection.

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Correspondence to Hailey H. Choi.

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This is a HIPAA-compliant, retrospective study approved by the Institutional Review Board. Informed consent was waived due to the retrospective nature of the study.

Conflict of interest

Lori M. Strachowski, MD, has received royalties from Elsevier and is a speaker for World Class CME. The remaining authors declare that they have no conflict of interest.

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Choi, H.H., Taliaferro, A.S., Strachowski, L.M. et al. How common are traumatic injuries to the epididymis? A study of prevalence, imaging appearance, and management implications. Emerg Radiol 28, 31–36 (2021). https://doi.org/10.1007/s10140-020-01814-0

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  • DOI: https://doi.org/10.1007/s10140-020-01814-0

Keywords

  • Trauma
  • Injury
  • Ultrasound
  • Epididymitis
  • Hematoma