Mass like Epididymitis with Complex Hydrocele ? TB
73-year male with granulomatous lung disease presents with acute right testicular pain. US showed mass like enlargement of the epididymis attached to and compressing the right testis with a small hydrocele
US in the sagittal plane through the right testis shows a mass in the tail of the testes with mass effect of the epididymis on the testis. Associated findings include thickening of the scrotal skin and a hydrocele
Ashley Davidoff MD 133286
US in the sagittal plane through the right testis shows calcifications in the mass in the tail of the epididymis suggesting chronicity. Again noted is the mass effect of the epididymis on the testis with associated findings of thickening of the scrotal skin and a hydrocele. These findings suggest acute on chronic epididymitis, and granulomatous disease such as TB and dystrophic calcifications are also a possibility
Ashley Davidoff MD 133293
Doppler US in the sagittal plane through the right epididymis shows mild hyperemia of the epididymis suggesting mild acute on chronic epididymitis.
Ashley Davidoff MD 133290Doppler US in the transverse plane through the right testis and epididymis shows normal vascularity to the right testis and mild hyperemia of the epididymis.
Ashley Davidoff MD 133296
2 weeks later US showed persistent but improved enlargement of the right epididymis.
2 weeks later US in the sagittal plane showed persistent but improved enlargement of the left epididymis and persistent skin thickening. Microcalcifications are noted in the testis
Ashley Davidoff MD 133302US in the sagittal plane of the left testis shows persistent mass effect of the epididymis on the testis. There is persistent skin thickening and hydrocele.
Ashley Davidoff MD 133305Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis and mild hyperemia of the epididymis, and skin thickening consistent with mild ongoing epididymitis.
Ashley Davidoff MD 133309
7 years Later
7 years later he again had pain and there was persistent recurrent epididymitis and simple hydrocele which progressed over the next few months to a complex hydrocele
7 years later he again presented with pain, and US in the sagittal plane through the right testis and epididymis shows significant persistent enlargement of the epididymis with heterogeneity with cystic spaces, skin thickening and a simple hydrocele consistent with the diagnosis of acute on chronic epididymitis of the right epididymis
Ashley Davidoff MD 133312
US in the transverse plane through the tail of the right epididymis again shows mass like heterogeneous appearance with mass effect on the testis, necrotic fluid collection, skin thickening and simple hydrocele
Ashley Davidoff MD 133313Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis, moderate hyperemia of the epididymis, associated with skin thickening and hydrocele consistent with acute on chronic ongoing epididymitis.
Ashley Davidoff MD 133320
2 months later
2 months later US in the transverse plane through the scrotal sac is dominated by a large complex loculated hydrocele compressing the enlarged right epididymis and testis.
Ashley Davidoff MD 133330Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis and epididymis, both significantly compressed by a complex hydrocele.
Ashley Davidoff MD 133330
A Further 2 Months Later
2 months later US in the transverse plane through the scrotal sac is dominated by a large complex loculated hydrocele characterized by progressive thickening of the septations compressing the right testis.
Ashley Davidoff MD 133332
These findings and the chronic history are most consistent with Tuberculous epididymitis
