IS Case 123: Bilateral epididymo-orchitis

Lisa Siripun, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20


Patient is a 54-year-old male with a history of recurrent epididymitis presents with scrotal pain, clear urethral discharge and fever.


Bilateral epididymo-orchitis


Scrotal inflammatory disease usually involves the epididymis initially and spreads to the testis, scrotal sac and scrotal wall. Orchitis develops in 40% of patients with epididymitis. Isolated orchitis is less common and generally is viral (i.e. mumps).

Sonographic findings: These include enlarged epididymis and testis, heterogeneous parenchyma, epididymal head measures > 17 mm, reactive hydrocele and skin thickening.

Color Doppler findings: Increased vascularity and increased concentration of the vessels within testis and epididymis. Hyperemia is the distinguishing characteristic of this disease, but normal blood flow can be seen in the epididymis with high frequency transducer sonography; therefore, comparison with the other side is important.

Differential diagnosis: Includes torsion, diffuse lymphoma or leukemia, and diffuse seminoma. It is very important to correlate with clinical setting in all these patients.

All patients with heterogeneous appearance of the testis should be followed up to demonstrate sonographic resolution after antibiotic treatment to exclude the possibility of tumor. Complications of epididymo-orchitis include abscess, pyocele, infarction, infertility, atrophy and gangrene.


  1. Middleton, W., Kurtz, A. Ultrasound: The Requisites. 2nd ed. Philadelphia, Pennsylvania: Mosby, 2004:171-174.
  2. Dogra, V and Rubens DJ. Ultrasound Secrets, Hanley and Belfus, 2004:251-253.

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