The role of diagnostic CT imaging in the acute assessment of battlefield external genital injuries.

INTRODUCTION: The external genitalia are routinely included in the 'CT-Traumagram' at the Role 3 hospital in Afghanistan. Although the radiologist may have the opportunity to diagnose clinically undetected genital injury, little emphasis has been placed on the CT appearances of the external genitalia after Improvised Explosive Device related injury.

METHODS: A prospective observational study was carried out on casualties admitted during 1 month in 2011. Genital findings on CT were correlated with clinical operative findings.

RESULTS: One hundred and twenty-eight casualties were admitted of which 12 (9%) had genital injury. 17 testes were exposed to blast injury-5/17 (29%) were unharmed, one was dislocated, two were lost, one had a testicular haematoma and 8/17 (47%) were disrupted and underwent salvage. The CT findings-loss of the definition of the tunica albuginea and intra-testicular contrast blushing correlated with testicular disruption in all cases. The single dislocated testis and the two cases where there were no testes remaining after injury were all evident on CT.

DISCUSSION: The CT appearance of the external genitalia following trauma are unfamiliar. However, despite the small numbers and clear limitations, the results suggest that CT has an important role to play in the diagnosis of significant genital trauma. Ultrasound assessment should be considered if there is persisting uncertainty.

CONCLUSIONS: 'CT-Traumagram' provides rapid, whole body information in casualties exposed to blast injury and this should be exploited in its entirety by the trauma team. Abnormal genital findings on contrast CT should alert radiologists and surgeons to the possibility of significant genital trauma.