Doppler US in the longitudinal plane through the right testis shows hypervascularity both of the of the right testis and epididymis, consistent with the diagnosis of acute orchitis and epididymitis . Ashley Davidoff MD 133194 b02
Recurrent Epididymitis
65 year old Male with Recurrent Epididymitis
9 months prior presented with mild left sided testicular pain
US in the sagittal plane of the body and tail of the epididymis shows diffuse enlargement of left epididymis reflecting chronic or mild acute on chronic epididymitis Ashley Davidoff MD 133157b06
9 months later 65 year old male presents with recurrent pain in the left testis
The Snowstorm Hydrocele and Swollen Spermatic Cord
74 Year Old Male with Pain and Swelling of the Right Testis and Hydrocele
US in the sagittal plane through the right testis and epididymis shows mild thickening of the overlying skin and an enlarged epididymis associated with a small hydrocele consistent with the diagnosis of acute epididymitis Ashley Davidoff MD 133105
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 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
2 weeks later US showed persistent but improved enlargement of the right epididymis.
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
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 133313
2 months later
A Further 2 Months Later
These findings and the chronic history are most consistent with Tuberculous epididymitis
US in the sagittal plane through the right hemiscrotum shows a loculated collection in the left epididymis with compression of the left testis. Associated findings include overlying skin thickening. These findings are consistent with an epididymal abscess Ashley Davidoff MD 133175
US in the sagittal plane of the left spermatic cord shows enlargement and thickening of the wall consistent with extension of the inflammatory process from the epididymal abscess. Ashley Davidoff MD 133187
Pyogenic Orchitis Complicated by Infarction Following Prostate Biopsy
48 year old diabetic male presented with an elevated PSA for transrectal biopsy.
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
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
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 133237b01
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.