ARRS 2022 Abstracts

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E1655. CT Findings in Epididymo-orchitis and Funiculitis: Lesson Learned
Authors
  1. Rachana Borkar; Department of Radiology, Bridgeport Hospital-Yale New Heaven Health
  2. Ayah Megahed; Department of Radiology, Bridgeport Hospital-Yale New Heaven Health
  3. Rahul Hegde; Yale Diagnostic Radiology, Yale New Haven Hospital
  4. Anas Bamashmos; Department of Radiology, Bridgeport Hospital-Yale New Heaven Health
Background
Ultrasound (US) is the most appropriate and in most instances the only imaging modality sufficient for imaging evaluation of acute scrotal pathologies, including epididymo-orchitis (EO).With increasing use of CT in the emergency department (ED), patients with EO may get imaged with CT first, particularly if they have atypical presentation or predominantly abdominal symptoms.

Educational Goals / Teaching Points
This series of three cases reviews the range of CT imaging findings of EO and funiculitis (EOF)

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Case 1: 44-year-old (yo) man (M) with no comorbidities presented to the ED with acute right lower quadrant (RLQ) and groin pain. Laboratory evaluation was unremarkable. CT demonstrated hyperenhancing left spermatic cord and cord-like thickening of vas deferens. Subsequent US demonstrated marked hyperemia in the left epididymis and testis with thickened cord, confirming EOF. Case 2: 23-yo M presented to the ED with acute RLQ pain with dysuria. Urinalysis (UA) was supportive of urinary tract infection. Contrast-enhanced CT of abdomen and pelvis was performed with differential diagnoses (DD) of right lower abdominal pathology, like appendicitis or pyelonephritis in light of abnormal UA. CT revealed hyperenhancing right epididymis and an enlarged enhancing right spermatic cord. The inflammation extended along vas deferens into the pelvis and there was abnormal enhancement of the right seminal vesicle. Findings raised concern for EOF with intrapelvic extension of the infection to the level of the seminal vesicle. Subsequent US confirmed findings of EOF. Case 3: 47-yo M with poorly controlled diabetes mellitus and prior bilateral inguinal hernia presented to the ED with severe right inguinal pain radiating into scrotum for 1 day. Scrotum US was diagnostic of right funiculitis. He was discharged with oral antibiotics. He returned in 3 days with worsening symptoms despite adherence to antibiotics. CT imaging demonstrated soft tissue infiltrative changes involving the scrotum and surrounding perineal soft tissues extending to inguinal region with few foci of air. Diagnosis of aggressive emphysematous infection/early Fournier gangrene was made. He immediately underwent surgical excisional debridement. Postoperative CT imaging revealed no residual emphysema or collections. He was discharged with long-term outpatient intravenous antibiotic therapy.

Conclusion
This case series highlights the range of findings that can be seen on CT with EOF. Although not the primary modality for its diagnosis, CT may detect an atypical clinical presentation with a broad DD. Further, current literature supports the unique role of CT, especially in detection of emphysematous and complicated infections in this region. Radiologists should be aware of potential imaging findings on CT in EOF. Further, CT has an important role in evaluation of complicated infections with abscess formation, intrapelvic extension, and emphysematous infections.