Scrotal infection and fluid collection

Most common cause of acute scrotal pain in postpubertal men

Acute epididymitis

Epididymitis most commonly results from…

SexuaLly transmitted disease in males 14-35yrs and lower urinary tract infections in men over 35yrs

USA acute epididymitis

Thickening of the tail first, then entire gland

Head measures >17mm

Decreased echogenicity

Heterogeneous

Hydrocele

Hypervascularity

Epididymis enlarges post-vasectomy and may be similar in 2D appearance to acute epididymitis

HYPERVASCULARITY

Acute epididymitis

Bacterial Acute orchitis is most commonly caused by

Sexually transmitted disease

Viral Acute orchitis is most commonly caused by

Mumps

Acute orchitis

Same symptoms of acute epididymitis

Prehn sign:

• Used to differentiate from Epididymo-orchitis from torsion

• Lifting the painful scrotum above the level of the symphysis pubis will relieve pain when infection is the cause for symptoms

• No reduction in pain with torsion

Acute orchitis USA

Can be focal or diffuse

Decreased echogenicity

Hypervascularity in the area of infection

Decreased vascularity resistance (= hypervascularity) compared to unaffected side

RI <0.5 in affected testicle

Diastolic flow reversal in some cases of epididymo-orchitis = venous infarction

Orchitis

Abscess

Usually a complication of orchitis/epididymitis

Other causes include mumps, smallpox, typhoid and appendicitis

Abscess USA

Mixed echogenicity mass with fluid components

Void of color flow centrally with increased vascularity in peripheral tissues

Abscess

Tuberculosis

Heterogeneous epididymis

Nodule formation within the epididymis

Very little vascularity in or around the nodules

Fournier gangrene

Usually seen in diabetic patients

Infections causing acute necrotizing fasciitis of the perineum, scrotum and anterior abdominal wall

Pneumoscrotum - air in the scrotum caused by bacterial infection

CRITICAL

Hydrocele

Accumulation of serous fluid between two layers of the tunica vaginalis

Primary or congenital - usually identified in pediatric patients, caused by persistent communication between scrotal sac and peritoneum; most common

Secondary or acquired - Usually present after 40yrs; caused by trauma, torsion, tumors or inflammation

Most common cause of painless swelling

Hydrocele

USA hydrocele

Anechoic fluid collections

Good through transmission and posterior enhancement

Echogenic fibrin or cholesterol crystals may be seen floating freely

Larger fluid collections may require dual screen, panoramic imaging

A curved linear array may also be used to display a larger section of anatomy

Hydrocele

Hematocele

Blood collection in scrotal sac

Caused by trauma, torsion, surgery, diabetes or neoplasms

Hematocele USA

Contains low level echoes and visible fluid levels

May contain septations

No increase in vascularity surrounding mass helps to differentiate from pyocele

Hematocele

Pyocele

Collection of pus in scrotal sac

Caused by rupture of abscess

USA Pyocele

Similar to hematocele

Collection of fluid, debris, septations

May see thickened scrotal sac

Pyocele

Which of the following sonographic characteristics are shared by pts with acute epididymitis and those have had a vasectomy?

Gland enlargement

Hypervasculairty

Hypovascularity

Cystic degeneration

Gland enlargement

The prehn sign is used to differentiate:

Orchitis from torsion

Viral orchitis is typically caused by:

Mumps infection

Which of the following resistive index

0.4

If diastolic flow reversal is present on the Doppler tracing from an tratesticular artery, this indicates:

Venous infarction or partial torsion

A hydrocele refers to a collection of serous fluid:

Between the two layers of the tunica vaginalis

A hematocele is a collection of ____________ in the scrotum, while a pyocele is a collection of ________ in the scrotum

Blood; pus