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Age: 37

Sex: Male

Indication: Left testicle pain

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Case #15


Findings

  • Enlarged left testicle with normal contour and echotexture
  • Moderate left hydrocele without internal complexity
  • Increased vascularity to the left testicle and epididymis
  • Normal grayscale appearance and vascularity of the right testicle and epididymis


Diagnosis

Epididymo-orchitis

Sample Report

Enlarged left testicle with increased vascularity to the left testicle and epididymis, suggestive of epididymo-orchitis.

Moderate left hydrocele without internal complexity.


Discussion

  • Ultrasound is the modality of choice when evaluating the scrotum
  • In patients presenting with acute scrotum, make sure you know which side is the symptomatic side as this can be helpful in differentiating cases of epididymo-orchitis from torsion
  • While isolated epididymitis can occur, isolated orchitis is very rare
  • The primary finding on ultrasound in these cases is increased vascularity. Additional supportive findings include:
    • Enlarged testis and epididymis on the affected side
    • The testicular echogenicity may be increased, decreased, or heterogeneous relative to the unaffected side
    • Reactive hydrocele
  • Watch out for septations and echogenic material within the adjacent hydrocele, which if present raise concern for a pyocele


Images

Side-by-side views of the testicles are useful to compare vascularity. Note how the left testicular vascularity is asymmetrically increased in this case of left epididymo-orchitis.

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