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Epididymoorchitis


KEY FACTS

Terminology

  • Infectious inflammation of epididymis, testicle, or both

    • Orchitis much less common than epididymoorchitis

Imaging

  • Enlargement of affected tissues (i.e., testicle, epididymis, or both) with accompanying ↑ blood flow

    • ↑ blood flow best demonstrated on transverse side-by-side comparison view

    • Arterial waveforms typically remain low resistance

  • Echotexture may be ↑ or ↓, often heterogeneous

  • Reactive hydrocele

  • Scrotal wall also thickened

Top Differential Diagnoses

  • Torsion of appendage testis

  • Testicular torsion

  • Scrotal cellulitis

Pathology

  • Bacterial infections may be due to ascending infection (in sexually active adolescents), direct seeding by infected urine with GU anomalies (especially in young children), or hematogenous seeding

  • Can also be viral (typically mumps) or posttraumatic

  • Some cases of epididymitis likely due to unrecognized appendage torsion

Clinical Issues

  • Gradual onset of painful scrotum, swelling, erythema ± dysuria, enuresis, frequency

    • Prehn sign: Elevation of affected hemiscrotum relieves pain of epididymitis & exacerbates pain of torsion

  • Primary therapy: Antibiotics

  • Bedrest, scrotal support & elevation, ice packs, antiinflammatory agents, & analgesics also used

  • Consider work-up for GU anomalies in younger children & recurrent cases

Longitudinal graphic through the testis & epididymis shows a focally enlarged inferior aspect of the epididymis
due to epididymitis. If the testicle
were also enlarged & inflamed, this would be epididymoorchitis.

Longitudinal oblique color Doppler US shows a thickened, hyperemic, & heterogeneous epididymis
in a teenager with several days of pain, consistent with epididymitis.

Grayscale US in a 5-year-old boy with acute left scrotal swelling shows marked enlargement & heterogeneous echotexture of the epididymis
. The testicle
has a normal echotexture but was larger than the contralateral side.

Longitudinal color Doppler US of the same 5-year-old boy with left scrotal swelling shows enlargement of the epididymis
& testis
with increased blood flow & a surrounding hydrocele, consistent with epididymoorchitis.

TERMINOLOGY

Definitions

  • Infectious inflammation of epididymis, testicle, or both

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