Pyocoele

Severe
scrotal pain. Scrotal ultrasound revealed an enlarged right testicle, with multiple round hypoechoic lesions, many with low level internal echoes, suggestive of intra-testicular abscesses.
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Severe
scrotal pain. Ultrasound-Power Doppler image demonstrated right testicular and scrotal tissue hyperemia, secondary to the inflammatory/infectious process.
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Severe
scrotal pain. Scrotal pyocele around the right testicle: complex fluid collection with internal septae and loculations at US imaging.
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Acute scrotal
ultrasound: a practical guide. Epididymo-orchitis and complications. a Epididymo-orchitis. Longitudinal color Doppler US in a 31-year-old with acute left scrotal pain and recent diagnosis of Chlamydia trachomatis. There is extensive hyperemia of the epididymal head (arrowhead) and testis (arrow) compared to the contralateral side (not shown). The patient’s symptoms resolved after treatment with doxycycline. b Scrotal abscess. Transverse US image of the left testis in a 59-year-old paraplegic patient with recurrent epididymo-orchitis and scrotal abscesses. The left testis is nearly replaced by a heterogeneous fluid collection (small arrows). In the medial aspect, there is a cluster of echogenic foci (arrowheads) which result in reverberation artifact/‘dirty shadowing’ (large arrow) due to a gas component. Cultures following surgical drainage grew Pseudomonas aeruginosa and Enterobacter cloacae. c Vasitis. Longitudinal US image of the left inguinal canal in a 46-year-old with left scrotal and pelvic pain. There is hyperemia of the epididymal head and spermatic cord (arrow) as it traverses the inguinal canal. Note the normal-appearing superior aspect of the testis (arrowheads). d Vasitis. Axial CT image of the pelvis (same patient as in part c) shows an enlarged and inflamed left vas deferens (arrows). The right vas deferens is normal (arrowheads). The patient’s symptoms resolved after treatment with Ciprofloxacin
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Scrotal pyoceles are purulent fluid collections in the scrotal sac, that generally occur in conjunction with epididymo-orchitis.

Pathology

Scrotal pyoceles are typically a complication of epididymo-orchitis or testicular abscess but can also occur following trauma or surgery. The purulent fluid collection generally arises from communication between the infected testicle or testicular abscess and an existing hydrocele, through the mesothelial lining of the tunica vaginalis.

Radiographic features

Ultrasound

Ultrasound is the imaging modality of choice for investigation of scrotal pain and swelling or follow-up of a known epididymo-orchitis. Features of pyocele on ultrasound are:

  • complex, heterogeneous fluid collection in the scrotal sac with septa
  • gas may be present causing hyperechoic foci and shadowing

If the pyocele organizes into a scrotal abscess, there will be a distinct well-demarcated hyperemic wall around the purulent fluid collection.

Treatment and prognosis

Conservative management with antibiotics is generally sufficient for treatment of a pyocele, however surgical debridement may be necessary in more severe cases.

Differential diagnosis

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu skrotale Pyozele:
Hodenabszess
 
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skrotales
Trauma
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Epididymoorchitis
 
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