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Hypervascularity on color Doppler images [Fig. 20b] is a well-established diagnostic criterion and may be the only imaging finding of epididymo-orchitis in some men. [ citation needed ] Doppler ultrasound of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image).
Ultrasound can be useful if the diagnosis is unclear. [1] Epididymitis usually has a gradual onset. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle).
Doppler ultrasound of the scrotum, in the axial plane, showing orchitis (as part of epididymo-orchitis) as hypoechogenic and slightly heterogenic left testicular tissue (right in image), with an increased blood flow. There is also swelling of peritesticular tissue. Blood – ESR high; Urine – Cultural & Sensitivity test; Ultrasound scanning
Although elevation of the scrotum when differentiating epididymitis from testicular torsion is of clinical value, Prehn's sign has been shown to be inferior to Doppler ultrasound to rule out testicular torsion. [3]
When the testis becomes swollen, in addition to the epididymis, this is called epididymo-orchitis. Epididymitis can be acute (lasting less than six weeks) or chronic (lasting equal to or more than six weeks). [17] Pain experienced due to chronic epididymitis is usually more dull compared to acute epididymitis and can be intermittent.
The exact cause of an epididymal cyst is unknown, but it is most likely a congenital anomaly associated with hormonal imbalances during embryonic life. [3] Previous research has shown a correlation between the development of epididymal cysts and maternal exposure to endocrine disrupting substances like diethylstilbestrol during male fetal development.
Testicular sarcoidosis can present as a diffuse painless scrotal mass or can mimic acute epididymo-orchitis. Usually it appears with systemic manifestations of the disease. [ 3 ] Since it causes occlusion and fibrosis of the ductus epididymis, fertility may be affected. [ 4 ]
Secondary hydrocele is most frequently associated with acute or chronic epididymo-orchitis. It is also seen with torsion of the testis and with some testicular tumors. A secondary hydrocele is usually lax and of moderate size: the underlying testis is palpable. A secondary hydrocele subsides when the primary lesion resolves. [citation needed]