Pyogenic Orchitis Complicated by Infarction Following Prostate Biopsy
48 year old diabetic male presented with an elevated PSA for transrectal biopsy.
Transrectal biopsy with US guidance shows a mildly enlarged prostate. Pathology showed no evidence of malignancy with findings of BPH
Ashley DAvidoff MD 133209
10 days after a biopsy, he developed dysuria and hematuria. Urine culture showed E Coli, resistant to many antibiotics but sensitive to nitrofurantoin. He improved after 1 week of antibiotics, but symptoms recurred with right testicular pain and swelling with intermittent fever.
WCC was 18,000 and urine was cloudy with increased sugar
Doppler US showed epididymo-orchitis with no flow to the hypoechoic right testis consistent with an infarcted testis. The patient declined orchiectomy
US in the transverse plane through both testes shows decrease echogenicity of the right testis, enlargement of the right epididymis and thickening of the overlying skin consistent with the diagnosis of acute epididymitis and orchitis.
Ashley Davidoff MD 133211US in the sagittal plane of the right testis above and normal left testis below shows enlargement of the right epididymis, and testis, with thickening of the tunica albuginea, complex hydrocele with septations and thickening of the skin. The thickening of the tunica albuginea in this instance was a clue to the abnormality of the testis which was shown by Doppler to be infarcted
Ashley Davidoff MD 133227cDoppler US in the transverse plane through the right testis shows absent vascularity in the testis with mild heterogeneity consistent with infarction of the right testis. There is increase vascularity in the tail of the epididymis
Ashley Davidoff MD 133221Doppler US in the transverse plane through the right testis shows absent vascularity in the testis with mild heterogeneity consistent with infarction of the right testis. There is increase vascularity in the head of the epididymis consistent with epididymitis
Ashley Davidoff MD 133222US in the sagittal plane of the right testis shows enlargement of the head of the epididymis, complex hydrocele with septations and thickening of the skin.
Ashley Davidoff MD 133212US in the transverse plane of the right testis shows enlargement of the tail of the epididymis, complex hydrocele with septations and thickening of the skin.
Ashley Davidoff MD 133218Doppler US in the transverse plane through the right testis shows absent vascularity in the testis with mild heterogeneity consistent with infarction of the right testis. There is increase vascularity in the tail of the epididymis
Ashley Davidoff MD 133221
Doppler US in the transverse plane through the left testis shows no significant hypervascularity of the testis but mild increase in vascularity of the head of the epididymis. This finding in association with the noted mild hypo echogenicity in the presence of mild pain would suggest mild acute on chronic epididymitis and orchitis.
CT scan showed an enlarged right testis, induration of the surrounding skin, and around the prostate
as well as thickening and hyperemia of the cord
Coronal reconstruction of the CT scan of the pelvis shows hyperemic and enlarged spermatic cord, (orange arrow), enlargement of the right epididymis (red arrow) and normal left epididymis (white arrow)
Ashley Davidoff MD 133238
Axial CT scan through the scrotal sacs bilaterally show enlargement of the right epididymis (red arrow) and normal left epididymis (white arrow), infarcted right testis (black arrow) and normal left testis (yellow arrow).
Ashley Davidoff MD 133237b01Coronal reconstruction of the CT scan of the pelvis shows hyperemic and enlarged spermatic cord, (orange arrow), enlargement of the right epididymis (red arrow) and normal left epididymis (white arrow)
Ashley Davidoff MD 133237b02
4 weeks Later
US performed 4 weeks later showed reduction in the size of the right testis and showing a 7mm focal area of necrosis in the parenchyma.
US performed 4 weeks later showed reduction in the size of the right testis and showing a 7mm focal area of necrosis in the parenchyma. Associated findings include persistent but improved enlargement of the epididymis and overlying skin thickening
Ashley Davidoff MD 133248Doppler US in the sagittal plane through the right testis shows absent vascularity in the testis with hypervascularity of the head and tail of the epididymis consistent with ongoing but resolving epididymitis and infarction of the right testis.
Ashley Davidoff MD 133253
