*11 year-old boy with acute right scrotal pain.
What is the most likely diagnosis?
Answer
Answer: Epididymo-orchitis
Case Discussion:
Ultrasound image shows increased size and heterogeneous echogenicity of the affected epididymis. The color Doppler images demonstrate increased blood flow in the epididymis and testis, resulting from the active inflammation.
Epididymitis is inflammation of the epididymis, and can be associated with inflammation extending to the testis itself, in which case the term epididymo-orchitis is used. Epididymo-orchitis must be differentiated from testicular torsion, which is a surgical emergency. There are two peaks of prevalence (<2 years of age and >6 years of age). It is a medical condition characterized by acute unilateral scrotal pain.
Ultrasound findings
• Increased size of the epididymis
• Decreased, increased, or heterogeneous echogenicity of the affected organ, depending on the time of evolution
• Reactive hydrocele
• Increased blood flow within the epididymis, testis, or both, resulting from the inflammation produces.
Complications
• Infarction
• Epididymal abscess
• Testicular abscess
Differential diagnosis
• Isolated orchitis
• Granulomatous epididymitis
• Chronic epididymitis
• Testicular neoplasm
References:
1. Aso C, Enríquez G, Fité M et-al. Gray-scale and color Doppler sonography of scrotal disorders in children: an update. Radiographics. 25 (5): 1197-214.
2. Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 23 (1): 215-40.
3. Mandell J. Core Radiology. Cambridge University Press. (2013) ISBN:1107679680.