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Musculoskeletal/Small parts » Scrotum And Testicles
Complicated acute epididymo-orchitis: with an epididymal abscess
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Presentation A young adult male presents with a one day history of acute right scrotal pain. There is no history of trauma.
 
 
 
Caption: Transverse sonogram of the right scrotum.
Description: This scan shows an enlarged epididymis with a very heterogeneous appearance. A small hydrocele is also noted. The visualized testis appears normal.
 
 
 
Caption: Right transverse sonogram.
Description: The epididymal head appears markedly enlarged and heterogeneously hypoechoic. A few anechoic areas are noted in the center. A right hydrocele is also noted.
 
 
 
Caption: Transverse scan of the contralateral scrotum.
Description: Normal size and appearance of the testis and epididymis on the asymptomatic side is noted.
 
 
 
Caption: Color Doppler view on the symptomatic side.
Description: Increased vascularity is noted in the right epididymal head with a central area of avascularity, corresponding to abscess formation. The adjacent right testis also shows hyperemia that may be related to reactive orchitis.
 
 
 
Caption: Color Doppler view on the asymptomatic side.
Description: The left testis and epididymis demonstrate normal blood flow.
 
Differential Diagnosis Inflammation, neoplasm, hematoma, torsion of appendix testis or appendix epididymis
 
Final Diagnosis Right epididymitis with mild right orchitis and a reactive hydrocele. A developing abscess is seen in the epididymal head.
 
Discussion The role of ultrasound imaging in diagnosing inflammatory pathologies of the epididymis and testis and their complications has been discussed in an earlier case. Click here to view the case in a new window. Imaging is also of paramount importance in distinguishing this entity from testicular torsion or tumor presenting as acute scrotum.
 
Follow Up This patient was treated with antibiotics. No further follow up was available.
 
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