Saturday, October 30, 2010

Tuberculous epididymitis/ epididymo-orchitis:

This middle aged male patient presented with a mass in the left scrotum which was mildly painful. This ultrasound video shows a transverse section through the left scrotum, with the probe panning from the lower to upper poles of the left testis.
What do we see? Note the small hydrocele around the large, nodular hypoechoic mass in the lower pole of left testis. The mass originates in the tail of the left epididymis, and extends into the lower tip of the left testis.  In addition note the thickened scrotal wall. 
Have a look now, at the color Doppler and Power Doppler ultrasound videos of the left scrotum.

The above video clip is a color Doppler sonography study which shows marked vascularity of the "mass" in the tail of left epididymis. Note the thickened body of the left epididymis as we pan upwards.
What does this suggest? Clearly the mass is primarily a lesion involving the left epidiymis from body to the tail and the small hydrocele all point to an inflammatory pathology. The commonest cause of such an appearance is tuberculous epididymitis with orchitis (involvement of the adjacent left testis). The 2nd diagnostic possibility in such a case is pyogenic/ non tuberculous orchitis- in non tuberculous orchitis or non tuberculous epididymitis, the epididymis would be homogenously enlarged, compared to the inhomogenous mass that is seen in this case. See: Tuberculous epididymo- orchitis article(AJR)  
  This sagittal to parasagittal section Power Doppler ultrasound video clip of the left testis further confirms the findings mentioned above.
The last video- a zoomed in view of the mass:

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