Sonographic appearance of epididymal microlithiasis

Abstract

We report a case of epididymal microlithiasis that was diagnosed sonographically in a 75-year-old man undergoing scrotal sonographic examination to investigate right groin pain associated with an inguinal hernia. The sonographic appearance was that of multiple comet-shaped foci of microcalcification throughout both epididymides, with associated comet-tail artifacts. The testes had normal appearance with no evidence of testicular microlithiasis. The patient subsequently remained well after hernia repair. To our knowledge, epididymal microlithiasis has only previously been reported in a cadaveric study; the authors of that study hypothesized that the condition is caused by aging, with ischemia likely implicated in the pathogenesis. There are many other patterns of extratesticular calcification, including sperm granuloma, hematoma, and chronic epididymitis. We discuss how these differ in appearance from epididymal microlithiasis. Epididymal microlithiasis is a completely separate entity from testicular microlithiasis and should be recognized and dismissed by sonographers and radiologists.

Perspectives in Pediatric Pathology, Chapter 13. Calcifications in the Testis and Paratesticular Structures

“…This is an asymptomatic process and is not related to testicular cancer [96,97]. Its sonographic appearance is characteristic, featuring multiple comet-shaped foci of microcalcification throughout the epididymis [98].…”

Microlithiasis of the Epididymis in an Infertile Hemodialysis Patient

“…Epididymal calcifications may be seen on ultrasound as multiple comet-shaped foci of microcalcification in both of the epididymides, with associated comet-tail artifacts. There is no associated acoustic shadow (2 …”