Severe Acute Epididymo-Orchitis Complicated with Abscess and Testicular Necrosis – Case Report

Introduction

Acute epididymo-orchitis (the inflammation of one or both testes and epididymis) is a common urological diagnosis encountered by urologists and by emergency and primary care physicians. It should be differentiated from testicular torsion – a true urological emergency. Furthermore, acute epididymitis can be complicated by testicular abscesses or by testicular infarction, due to spermatic cord swelling and by the impairment of blood flow – conditions that should be easily recognized and properly treated.

The diagnosis is usually established based on clinical symptoms and physical examination, but also further examinations could be helpful in confirming the epididymo-orchitis diagnosis and in identifying complications. Differentiation between epididymo-orchitis and testicular torsion can sometimes be difficult. However, a referral to the urologist when testicular torsion is suspected should not be delayed by an ultrasonographic (US) examination. Contrast-enhanced ultrasonography (CEUS), as well as color Doppler ultrasound (CDUS) and power Doppler ultrasound (PDUS), could be really useful in assessing the blood flow to the scrotum and the testes. Unlike CDUS and PDUS, CEUS could help in evaluating focal testicular complications of epididymitis and in establishing the extent of the unviable tissue (Lung PF et al. AJR Am J Roentgenol 2012;199: W345).

The aim of this case report is to demonstrate the clinical value of CEUS in the acute setting of testicular diseases.