Background
Acute epididymitis is the commonest cause of acute scrotal pain. High-resolution ultrasound is the first modality of choice for the evaluation of patients with acute scrotal pain. It's important to differentiate epididymitis from other causes of acute scrotal pain such as testicular torsion, rupture, and orchitis because their management is different. The purpose of this exhibit is to review the key imaging findings and underlying pathologies that should be considered when interpreting scrotal ultrasound in the evaluation of epididymitis.
Educational Goals / Teaching Points
Review the anatomy of the scrotum, including the relationship of the spermatic cord, epididymis, and testicle. Discuss clinical signs and symptoms of acute epididymitis and the laboratory workup. Discuss the utility of ultrasound for the evaluation of acute epididymitis, highlighting the various grayscale and Doppler findings that support the diagnosis. Review the various etiologies of epididymitis, with corresponding US and CT imaging findings. Review the current treatment guidelines and the utility of follow-up imaging in these cases.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review the anatomic relationship of the spermatic cord, epididymis, and testicle. Etiologies of epididymitis and their imaging findings (infectious, granulomatous – TB, BCG vaccine, nongranulomatous, traumatic, medication induced – amiodarone, tumors presenting as epididymitis). Sonographic features of acute epididymitis (asymmetric enlargement and hyperemia of the epididymis, associated funiculitis or orchitis, other scrotal findings: scrotal wall thickening, reactive hydrocele).Sonographic features of chronic epididymitis. Review complications of epididymitis (abscess, infarction of testis, atrophy of testis). Post-epididymectomy imaging.
Conclusion
It is important for practicing radiologists to be familiar with sonographic features of epididymitis to differentiate from other entities presenting with acute pain for appropriate surgical versus nonsurgical triage.
