Orchitis

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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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
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)
Radiopaedia • CC-by-nc-sa 3.0 • de

Orchitis (plural: orchitides) is an infection of the testicle, which is rarely isolated, and when in conjunction with the epididymis is called epididymo-orchitis.

Pathology

Usually, bacteria retrogradely seed into the testis from the bladder or prostate. It can also be secondary to viral infection (e.g. mumps, Coxsackie virus).

Associations

Radiographic features

Ultrasound

Ultrasound is the gold standard investigation. When compared with the other testis in the 'sunglasses view' features of orchitis include relative:

  • hypoechogenicity: focal or diffuse
  • hypervascularity: focal or diffuse
  • swelling
  • scrotal wall thickening

A complex/septated hydrocele can be seen in the ipsilateral scrotum.

Differential diagnosis

  • intermittent testicular torsion 
    • ​reperfusion after intermittent torsion can present similarly on Doppler ultrasound with increased flow, but the patient's history allows differentiation
  • primary testicular malignancy should be considered, especially with focal changes
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Orchitis:
Hodenabszess
 
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skrotales
Trauma
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chronische
Epididymitis
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Tuberkulose
Nebenhoden
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