IS case 514: Epididymo-orchitis with epididymal abscess

Vikas Datta, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-09-10

History

Patient is a 50-year-old male with right testicular pain and swelling for the past 10 days.

Findings

See figures

Diagnosis

Epididymo-orchitis with epididymal abscess

Discussion

Epididymo-orchitis is most commonly seen in sexually active young men and is the most common etiology of acute testicular pain in post-pubescent males. The patient will commonly present with symptoms including: scrotal swelling, erythema, fever and dysuria. Prehn's sign, which refers to relief of pain with lifting of the testes over the pubic symphysis, can be a helpful hint in making the distinction between epididymitis and testicular torsion. Abscess formation can be a complication, with epididymal and testicular abscess formation each occurring in up to 6% of cases.

The imaging modality of choice for the diagnoses of epididymo-orchitis is Doppler ultrasound. Early epididymitis often occurs in the tail, with orchitis almost always being secondary to contiguous spread of infection from pre-existing epididymitis. Orchitis occurs in 20-40% of cases of epididymitis. In acute epididymitis, the epididymis is enlarged and heterogeneously decreased in echogenicity, with hyperemia seen on Doppler. In orchitis the testes are diffusely enlarged and heterogeneous with hyperemia being variably seen in the testes; however, hyperemia is almost always seen in the epididymis. Decreased vascular resistance is also commonly seen in patients with epididymo-orchitis. Complications can results in vascular comprise and testicular infarction, with sonographic features which make the differentiation from testicular torsion difficult. Reversal of arterial diastolic flow is an ominous finding and associated with impending testicular infarction.

References

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

3 images