Varicocele usually no sign, sometimes bluish color through light scrotal skin. Chapter 4 scrotal ultrasound etai goldenberg and bruce r. Candel, wheelock and grimaldi 1 observed a case of mumps in which bilateral epididymitis preceded the appearance of bilateral orchitis by two days. It is important to get medical help for this condition. It results from the injury to the vessels that course along the inguinal canal. Mar 07, 2019 acute epididymitis is the most common condition that causes acute scrotal pain in adults, although acute epididymitis, testicular torsion, and testicular tumors can have a common presentation of pain. This should be distinguished from isolated orchitis, which is by comparison much less common. All providers of pediatric health care should understand the etiology and. Ultrasonography and ultrasound of epididymis epididymitis and. Epdiical for epididymitis treatment and symptoms, causes epididymitis is defined as the wound tube inflammation at the back of the testicle that stores and also conveys sperm. One of the most common causes of pain in the scrotum is epididymitis inflammation of these coiled tubes which may be due to an infection. Epididymitis is common and can cause substantial shortterm morbidity eg, suffering and loss of time from work and longterm complications eg, infertility, chronic epididymitis, etc. Local complications are frequent recurrent infections, impaired wound healing. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Etiological factors may be infectious or noninfectious. Inflammation of the testicle is commonly also present. A testicular ultrasound is a lowrisk procedure that is used to diagnose a range of medical issues, such as testicular torsion, testicular cancer, and epididymitis. Acute epididymitis is the most common cause of an acute scrotum in adult males. At pathology, the earliest lesions are seen as discrete or conglomerate yellowish, necrotic areas in the tail of the epididymis.
Epididymitis is most often caused by a bacterial infection, including sexually transmitted diseases stds, such as gonorrhea or chlamydia. A rare case of isolated tuberculous epididymitis in a. Sometimes, the cause is a sexually transmitted disease. Rare causes include infection by certain viruses or fungi. Infection can result from surgery, the insertion of a catheter into the bladder, or the spread of infections from elsewhere in the urinary tract. Despite its high sensitivity and specificity, both falsenegative and falsepositive findings occur. Epididymitis indurated, swollen, and tender epididymis. Acute epididymitis and orchitis in children american. His pain had begun earlier that morning when he awakened with nausea and vomiting. It is important to rule out abscess formation, involvement of the testicular parenchyma and rule out testicular torsion with doppler ultrasound see below. Normal ultrasound appearances of the testis and epididymis. Acute epididymitis is inflammation of the epididymis characterized by scrotal pain and swelling of less than 6 weeks duration. Bladder outlet obstruction and urogenital malformations are risk factors for this type of infection.
Epididymitis is the commonest intrascrotal inflammation. Ultrasonography and ultrasound of epididymis epididymitis. Eo causing severe complications is uncommon with a study by desai et al. Cefuroxim 500 mg 101 or ciprofloxacin 500 mg 101 or other quinolone for at least 10 days. Epididymitis, an inflammatory process involving the epididymis, is one of the primary etiologies of the acute scrotum syndrome. We also found an increased incidence for at between september and march, although the incidence of epididymitis was quite even p.
The testes are homogenous and of mediumlevel reflectivity fig. The impact of color doppler ultrasound on treatment. Testicular ischemia after inguinal hernia repair request pdf. Albert einstein college of medicine, bronx, ny acute epididymitis and orchitis result in pain and swelling of the contents of the scrotal sac. Jason levy, md, northside radiology associates, atlanta, ga. Documented rates of eo are around 50 per 100 000 outpatient visits, with comparable rates in all ages. Full epididymitis tender vasectomy sites palpable nodule o. Aug 23, 2018 download pdf copy by yolanda smith, b. Orchitis is inflammation of the testis, but the term has also been used to describe pain localized to the testis without objective evidence of inflammation.
Browse our free ultrasound library offered to you by sonoskills and hitachi medical systems europe. Diplomado ultrasonido diagnostico en ginecoobstetricia entrenamiento practico. The mean postvoiding residual volumes in patients with acute and recurrent acute epididymitis were 47. Clinical features of testicular torsion and epididymo. Epididymitis causes an inflamed and painful testicle. Diseases of the testis and epididymis radiology key. Epididymitis is a relatively common clinical condition presenting as acute or chronic forms. Clinical manifestations of this rare situation are variable and may include. Discussion although the scrotum is a superficial structure, clinical examination is frequently not enough for making a specific diagnosis. Clinical features of testicular torsion and epididymoorchitis in infants younger than 3 months article in journal of pediatric surgery 429. More frequently, however, acute scrotum occurs without a precipitating factor.
The values presented on this website are provided for indicative purpose only and may contain errors. The main symptoms are pain and swelling of the scrotum the sac containing the testicles. Full text get a printable copy pdf file of the complete article 1. Swelling and sonographic epididymal abnormalities, skin thickening, and hydrocele are more suggestive of an infectious process than of tumor. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Behind each testis lies a tubular structure called. Testicular us demonstrates increased vascularity in the left testis and epididymis in keeping with epididymoorchitis. Gilbert the arthur smith institute for urology, north shorelong island jewish health system, 450 lakeville road, ste. Department of pediatrics, stony brook university school of medicine, stony brook, ny 1. Scrotal sonograms were obtained in 31 men before vasectomy and at 2 and 12 months after vasectomy to determine the effect of the surgery on the sonographic appearance of the testis and epididymis. The impact of color doppler ultrasound on treatment patterns. Epididymitis, orchitis most cases of epididymitis, with or without orchitis, are caused by common urinary pathogens. Mcgowan, john krieger, in mandell, douglas, and bennetts principles and practice of infectious diseases eighth edition, 2015.
The differential diagnosis in a patient presenting with acute scrotal pain may pose a diagnostic dilemma, and ultrasound can play a key role in effectively narrowing down the differentials and distinguishing acute epididymitis, acute epididymoorchitis and. Cases in men younger than 35 are commonly associated with a sexual transmitted infection, while the reverse is true over 35 years of age. Laser magnetic therapy for acute epididymitis and acute. Isolated orchitis is significantly less common than prostatitis or epididymitis. While most traumatic testicular injuries resolve with conservative management, many require surgical exploration and some are lifethreatening. Epididymitis and epididymoorchitis mens health issues. Global testicular infarction is a rare sequela of infectious epididymitis, with few reports in the urologic literature since the introduction of fluoroquinolones in the late 1980s. While genitourinary tuberculosis gutb accounts for up to 30% of extrapulmonary tb, epididymal involvement accounts for only about 20% of gutb 1,2. Acute inflammation of epididymitis ae, which can be met as separately and also with an acute iifflammatory process in testicleepithdymoorchitis aeo is. There is no replacement for good clinical judgement and the authors cannot be held liable for any mistake of harm resulting from the use of this website or its content. Epididymoorchitis is the spread of the infection to the testicle.
At ultrasound, epididymitis typically manifests as a thickened, hypoechoic epipidymis that demonstrates increased blood flow when doppler is used occasionally, this hypervascularity is the only finding. Scrotal pain and swelling is typically unilateral in epididymitis. Epididymitis and epididymoorchitis are usually caused by a bacterial infection. To compare historical features, physical examination findings, and testicular color doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. Testicular tumor firm nodule or harderthannormal section of testicle. Epididymitis is a health condition that involves pain and inflammation of the epididymis, as a result of various causes. Testicular ischemia is a rare complication of inguinal hernia repair. The epididymis is a series of small tubes that collects and stores sperm. Testicular and scrotal masses american academy of pediatrics. This brand new website is still in development, make sure to signup for our newsletter to stay uptodate on new features. Epididymitis refers to inflammation of the epididymis, and may be associated with inflammation extending to the testis itself, in which case the term epididymoorchitis is used. Chapter 4 scrotal ultrasound bruce r gilbert md php pc.
Acute painful scrotum in children may be associated with torsion of the testis, hematocele, epididymitis and direct testicular injury with hematoma formation. The differential diagnoses include torsion of the spermatic cord, torsion of the appendix testis, hernia, hydrocele, and trauma. In prepubertal boys and men older than 35 years of age, the disease is most frequently caused by escherichia coli and proteus mirabilis prehn described the clinical differentiation of. Differentiation of epididymitis and appendix testis torsion. Acute epididymitis is a clinical syndrome consisting of pain, swelling, and inflammation of the epididymis that lasts epididymitis is characterized by. Ultrasound scrotum ultrasound imaging of the scrotum uses sound waves to produce pictures of a males testicles and surrounding tissues. Scrotal ultrasound should be considered as a routine investigation in the management of epididymitis. Epididymitis accounts for 75% to 80% of acute inflammatory disease of the scrotum. This focused their attention upon the epididymis, and they concluded from a study of 105 cases of mumps, of which 23 developed orchitis, that epididymitis is frequently associated with orchitis. Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow.
Epididymitis clinical infectious diseases oxford academic. Only a paucity of cases regarding epididymoorchitis and scrotal involvement without renal or pulmonary involvement has been reported until today 3,4,5. Ultima revision 412018 version en ingles revisada por. Acute epididymitis is the inflammation of epididymitis accompanied by pain and swelling, while chronic epididymitis may present only with pain. Both testicles may be affected by orchitis at the same time. Presence of documented doppler flow within the testis might be a dissuading factor for surgical exploration with. If epididymitis is thought to be caused by gonococcal or chlamydial infection, treatment should include ceftriaxone rocephin, a single 250mg dose. Epididymoorchitis ultrasound a common indication for scrotal ultrasound is for the diagnosis of epididymitis or epididymoorchitis. Full epididymitis tender vasectomy sites palpable nodule o labs us w doppler epididymal thickening, epididymal tubular ectasia, blood flood o tx 1 st line nsaids, scrotal eval 2 nd line spermatic cord block surgical intervention o epididymectomy, vasectomy reversalvaricocele o hx dull, aching, throbbing sensation in scrotum exacerbated by. Derchi3 2medical school, university of zagreb, 3department of radiology, university of genoa corresponding author. Epididymitis can be a sexually transmitted disease, but not always.
However, the symptoms are usually in just one testicle. The age distribution for epididymitis has been quite even, with a slight increase in the pubertal period. Pdf tuberculous epididymitis mimicking a testicular. Epididymitis is an infection or inflammation of the epididymis, a structure that carries sperm from the testicles.
Sharp, md, mba, and kathleen kieran, md, university of iowa carver college. Scrotal lumps watch video fact sheet scrotal lumps fact sheet download pdf see all resources. Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. It is the primary method used to help evaluate disorders of the testicles, epididymis tubes immediately next to the testicles that collect sperm and scrotum. Consider chlamydia trachomatis infection in the younger male population. Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Downloaded from the american family physician web site at. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination.
Epididymitis is the most common cause of acute scrotum in adolescent boys and adults. Tuberculosis epididymitis usually starts in the tail of the epididymis, either because it has a greater blood supply or because, along with the vas deferens, it is the first portion to be involved by urinary reflux 2, 6, 7. In epididymitis, ultrasound imaging shows an enlarged epididymis, often together with a hydrozele ultrasound imaging. Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. We report a case of multidrug resistant epididymitis following prostate biopsy that progressed to global. The clinical spectrum ranges from mild epididymal tenderness to a severe illness with epididymal and testicular pain, scrotal wall thickening, reactive hydrocele, abscess formation, concomitant orchitis, testicular infarction, and sepsis. Multidrug resistant epididymitis progressing to testicular. Epididymitis represents the fifth most common urologic diagnosis in men between 18 and 50 years of age and can result in many days of lost work and pain. Men and boys with epididymitis classically present with posterior testicular pain that is gradual in onset, usually unilateral, and occasionally radiates to the lower abdomen.
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