We present our experience with intratesticular hematoma (ITH) without rupture of the tunica albuginea following blunt scrotal trauma and present an algorithm for management. We reviewed the charts of 3 patients who presented between 2006 and 2013 with this finding. Time from the incident to presentation ranged from 5 hours to 4 days. All patients underwent at least one scrotal ultrasound reviewed by the same urologist. Two patients underwent surgical exploration and all patients had resolution of pain within one to two days. Management of ITH should be centered on the patient's pain severity as well as serial ultrasound findings.