SONOGRAPHY IN PATIENTS WITH GUNSHOT WOUNDS OF THE SCROTUM - IMAGING FINDINGS AND THEIR VALUE

OBJECTIVE. The purposes of this study were to characterize sonographic findings in patients with scrotal injuries caused by gunshot wounds a nd to determine if sonography can be used to detect and differentiate various scrotal abnormalities, If patients are managed conservatively, less serious injuries (hydroceles, hematoceles, and scrotal hematomas ) must be separated from those requiring urgent surgical repair (testi cular rupture). MATERIALS AND METHODS. Sonograms obtained in 19 patien ts to evaluate gunshot wounds to the scrotum were studied for evidence of testicular rupture, extratesticular soft-tissue abnormalities, and the presence and location of foreign bodies. The results were compare d with clinical (19 patients) and surgical (six patients) findings. RE SULTS. Retrospective review of the sonograms showed normal testicles w ithout evidence of rupture in 11 patients, eight of whom had scrotal h ematomas, hydroceles, or hematoceles. Nine of the 11 patients were tre ated conservatively, and their symptoms resolved, In one of the other two patients, a prominent vessel was initially mistaken for a fracture plane; the testicle was found to be intact at surgery. The other pati ent was taken to surgery to remove a bullet in the peritesticular soft tissues; surgery demonstrated intact, viable testicles bilaterally, b ut both epididymides had through-and-through tracts from the bullet, T wo patients had sonolucent tracks from missile pathways in otherwise n ormal appearing testicles. Testicular rupture was sonographically dete cted in six patients. Sonograms in all patients with surgically confir med testicular rupture showed heterogeneous echogenicity and loss of s mooth oval contour, In one patient, the sonogram showed a fracture pla ne, Sonograms showed foreign bodies in five patients and localized the m to the testicular parenchyma (one patient) and to extratesticular so ft tissues (four patients). CONCLUSION. Sonography can distinguish var ious scrotal abnormalities caused by ballistic trauma, information tha t can be useful to the urologist if conservative management is conside red, Sonography can be used to distinguish less serious injuries such as scrotal hematomas, hydroceles, and hematoceles from surgical emerge ncies such as testicular rupture, Foreign body presence and location c an also be determined. Epididymal injuries were not well visualized.