Emergency Ultrasound > Top 10 Pathology > Epidydimoorchitis


Acute epididymoorchitis is an ascending infection usually tracking from the upper urinary tract or prostate down into the epididymis and eventually making it to the testicle. Most patients present with acute pain and swelling. Torsion of a testicular appendage mimics the diagnosis of epididymoorchitis, but is a self-limited condition that is treated symptomatically. Clinically, the cremasteric reflex is preserved and a bluish palpable nodule is identified at the region of the torsed appendage. Subsequently, this torsed appendage may atrophy and calcify and may be visualized in subsequent imaging studies as the finding of a "scrotal pearl" (Fig 5d).

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Fig 5 a. Epidydimo-orchitis, b. Epidydimitis flow, c. Orchitis flow.

Findings of epididymitis-orchitis include hyperemia, decreased echogenicity of the affected testicle, scrotal wall thickening and a hydrocele (Fig 5a, 5b, 5c). These findings can be seen in either epididymitis or orchitis of the testicle and both structures should be thoroughly analyzed. Treatment is with antibiotics if no complicating features are identified. Complications if untreated epididymo-orchitis include infarction, abscess (Fig 5e), a draining scrotal sinus, infertility and chronic epididymitis.

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Fig 5 d. Scrotal Pearl, e. Abscess.

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