Tuberculous Epididymitis and Epididymo-Orchitis: Sonographic Findings

Abstract

The findings at scrotal sonography in 10 patients with tuberculous epididymitis and in 2 with nontuberculous epididymitis are presented. In 6 patients with tuberculous epididymitis the testes were also involved (epididymo-orchitis). The most notable sonographic findings of tuberculous epididymitis were an enlarged epididymis, predominantly in the tail portion, and marked heterogeneity of the echo texture of the involved epididymis. Sonographic findings of associated testicular involvement consisted of a diffusely enlarged hypoechoic testis or ill defined focal intratesticular hypoechoic areas, or an irregular margin between the testis and epididymis. The sonographic findings encountered in patients with tuberculous epididymitis appear to be different from those encountered in nontuberculous epididymitis. Sonography might prove helpful in aiding the clinical distinction between these 2 forms of epididymitis and in demonstrating associated testicular involvement in tuberculous epididymitis.

Role of high resolution sonography and color Doppler flow imaging in the evaluation of scrotal pathology

“…Strikingly similar observations were noted in patients with tuberculous and non-tuberculous epididymo-orchitis by Kim et al in a study of 123 patients (Figure 7). 16 The epididymal lesions were hypervascular on CDFI and PD in nearly 70% of cases. PSV >15 cm/sec and RI <0.7 were less reliable for diagnosis as compared to the reliability of these criteria in acute inflammations.…”

Sonographic findings in tuberculous epididymo‐orchitis

“…Evidence suggests that tuberculous epididymitis usually develops initially in the tail of an epididymis, either because the tail has a greater blood supply than other parts of the epididymis or because it is the first portion involved by reflux along the vas deferens. 11 Findings by Kim et al 16 and Drudi et al 14 support this hypothesis, while those of Chung et al 7 do not, suggesting instead that infection more frequently involves the entire epididymis or its head.…”

“…4,9,20 Although bilateral scrotal involvement was previously accepted as a diagnostic rule, recent reports have documented unilateral disease. 7,11,16,21 Clinically, scrotal pain and swelling are the most common symptoms of genitourinary tuberculosis. Some cases are insidious and chronic, with painless or only slightly painful, minimal epididymal enlargement.…”

Scrotal sonography revisited

“…The epididymis can be involved solely, demonstrating heterogeneously hypoechoic echotexture, enlargement, and mildly increased peripheral blood flow. 23 Concomitant testicular involvement is usually the result of direct extension from the epididymis. Bilateral involvement has been reported in up to 22% of cases.…”