Scrotal and penile trauma is relatively uncommon, and imaging is frequently performed to assess the vascular integrity and severity of injury [1]. Three percent to 10% of trauma patients have associated genitourinary tract injuries, with male genitalia being particularly involved with associated pelvic injuries [1].  Nevertheless, scrotal contents can be injured when the scrotum is squeezed between the thighs or compressed against the pubic rami or by objects moving at high velocities [2]. Ultrasound can help in identifying the extent and type of injury so that testes can be salvaged with an early exploration [1].

Sonographic appearances of scrotal trauma can be broadly classified into intratesticular and extratesticular findings [1].

The exact incidence of epididymal injury in scrotal trauma is not known, but according to unpublished data of the authors, it was seen in 18 of 63 patients who had scrotal trauma [1]. Enlargement and hyperemia of epididymis have been described secondary to scrotal trauma [3]. This presentation is called traumatic epididymitis [4].

Following trauma, epididymis may reveal the presence of small contusions or hematomas within, resulting in its enlargement and inflammatory response. Color flow Doppler evaluation reveals absence of blood flow within these hematomas or contusion, with surrounding reactive hyperemia [1]. Presence of these changes should not be interpreted as infectious epididymitis; correlation with relevant history is important. Ultrasound findings are similar to infectious epididymitis, including epididymal enlargement and hyperemia [4].Trauma to the epididymis may be associated with hematoceles [1].

Traumatic epididymitis may occur as an isolated finding especially in less severe scrotal injury [5].

Differentiation between the 2 entities should be based on the history of trauma because the management of traumatic epididymitis does not require antibiotics [5].