Epididymitis

Doppler
ultrasound of the scrotum of a 70 year old man with left-sided pain in the region, as well as CRP elevation. It shows epididymitis by a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is not significantly increased (7 mm at top, 6 mm at bottom).
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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
theultrasoundjournal.springeropen.com • CC-by-2.0
Extrapulmonary
tuberculosıs: an old but resurgent problem. A 38-year-old male. Scrotal US image (a) and post-contrast coronal T1 weighted MR image (b) reveal diffuse heterogeneity, deformation, and dilated cystic lump with peripheral enhancement in the right epididymis (arrows)
insightsimaging.springeropen.com • CC-by-4.0
Epididymal
abscess: the value of Contrast enhanced ultrasound. Contrast-enhanced ultrasound image, at 44 seconds after microbubbles administration clearly confirmed the presence of increased peripheral vascularity but no blood flow within the mass.
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Epididymal
abscess: the value of Contrast enhanced ultrasound. Multiple blood flow signals were found at the periphery of the lesion, along with some greater blood vessels, possibly perfusing internal septations.
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Epididymal
abscess: the value of Contrast enhanced ultrasound. There was increased vascularity at the periphery of the lesion.
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Epididymal
abscess: the value of Contrast enhanced ultrasound. The hypoechoic mass containing echogenic septations and foci was seen along with thickening of the right scrotal wall.
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Epididymal
abscess: the value of Contrast enhanced ultrasound. Oblique sonogram of the right hemiscrotum shows hydrocele with multiple echogenic septations.
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School ager
with bilateral scrotal pain and a skin rash. Transverse color doppler US of the scrotum shows enlargement and hypervascularity of the bilateral crescent shaped epididymides when compared to their respective round testicles, to which they are lateral in position.The diagnosis was bilateral epididymitis in a patient with Henoch-Schonlein Purpura
pediatricimaging.org • CC-by-nc-sa 4.0
Doppler
ultrasound of the scrotum, in the axial plane, of a 70 year old man with left-sided pain in the region, as well as CRP elevation. It shows orchitis (as part of epididymo-orchitis) as a hypoechogenic and slightly heterogenic left testicular tissue (right in image), with an increased blood flow. There is also swelling of peritesticular tissue.
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Doppler
ultrasonography of a testicle (left in image) and an epididymis (right in image). The latter is swollen and has increased blood flow, which are typical findings in epididymitis.
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Global
testicular infarction • Testicular infarction secondary to epididymo-orchitis - Ganzer Fall bei Radiopaedia
Alhusseiny K, Testicular infarction secondary to epididymo-orchitis. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-79903 • CC by-nc-sa 3.0 (modified)
Preschooler
with right scrotal pain. Sagittal color doppler US of the right scrotum shows increased flow to the right epididimis compared to the flow in the right testicle, which was shown to be present on spectral doppler US.The diagnosis was right epididymitis.
pediatricimaging.org • CC-by-nc-sa 4.0
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Epididymitis refers to inflammation of the epididymis and may be associated with inflammation extending to the testis itself, in which case the term epididymo-orchitis is used. This should be distinguished from isolated orchitis, which is by comparison much less common.

Epidemiology

There are two peaks of prevalence: <2 years of age and >6 years of age.

Associations

Clinical presentation

The clinical spectrum ranges from mild tenderness to a severe febrile process with acute unilateral scrotal pain.

Pathology

The infection usually originates in the bladder or prostate gland spreads through the ductus deferens and the lymphatics of the spermatic cord to the epididymis, and finally reaches the testis, causing epididymo-orchitis. Due to this progression, infection starts in the tail of the epididymis.

Radiographic features

Ultrasound

The epididymal tail is the most affected region, and reactive hydrocele and scrotal wall thickening are frequently present. As the infection spreads, it can ascend the body and later the head of the epididymis.

Increased size and, depending on the time of evolution, decreased, increased, or heterogeneous echogenicity of the affected organ are usually observed.

The inflammation produces increased blood flow within the epididymis, testis, or both. Pulsed wave Doppler interrogation yielding an epididymal peak systolic velocity (PSV) greater than 15 cm/sec is highly suggestive of epididymitis, especially when the PSV on the affected side is significantly higher than the unaffected (with a ratio > 1.7) .

Analysis of the epididymal waveform may reveal a low-resistance pattern as compared with the normal pattern; a resistive index (RI) < 0.5 is frequently present .

Nuclear medicine

Pertechnetate scintigraphy can be used in evaluating acute scrotum. Increased perfusion and uptake of the scrotal contents are characteristic of epididymo-orchitis. In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymis.

Treatment and prognosis

The vast majority of patients are managed with simple analgesia and oral antibiotics.

Complications

Complications of epididymo-orchitis include:

Differential diagnosis

Differential considerations include

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Epididymitis:
Orchitis
 
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Hodenabszess
 
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skrotales
Trauma
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chronische
Epididymitis
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Tuberkulose
Nebenhoden
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Epididymoorchitis
 
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