Ultrasound Imaging Findings of Acute Testicular Infection in Patients With Coronavirus Disease 2019

Abstract

Objectives-Coronavirus disease 2019 , caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in Wuhan, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation.Methods-We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups.Results-A total of 142 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the nonsevere COVID-19 group (P = .037).Conclusions-This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.

SARS‐CoV‐2 infection affects the lower urinary tract and male genital system: A systematic review

“…Low flow priapism was reported in 2 patients 23,30 . Scrotal ultrasound was performed in 4 studies 20–22,24 : acute orchitis was found in 10 patients, acute epididymitis in 7, and acute epididymo‐orchitis in 16 20, 22, 24 ; one case of bilateral nonspecific intratesticular increased blood flow was also described 21 …”

“…COVID‐19 severity was available for 439 patients, but it was classified differently by the authors. The patients classified as asymptomatic or with mild, moderate, severe, and critical disease were 53, 166, 9, 37, and 14, respectively; Chen et al, however, merged patients with mild/moderate disease (83 cases) and those with severe and critical disease (59 cases) 20 …”

“…Male genital tract involvement was investigated in 11 studies [17][18][19][20][21][22][23][24][25]30,31 (Table 3). Scrotal discomfort was described in 8 patients, swelling in 14, pain in 16, and erythema in 1.…”

“…Low flow priapism was reported in 2 patients. 23,30 Scrotal ultrasound was performed in 4 studies [20][21][22]24 : acute orchitis was found in 10 patients, acute epididymitis in 7, and acute epididymo-orchitis in 16 20,22,24 ; one case of bilateral nonspecific intratesticular increased blood flow was also described. 21 Alkhatatbeh et al 22 observed 253 COVID-19 male patients and failed to observe symptoms or signs of orchitis across all age groups and different disease status.…”

Radiological patterns of incidental epididymitis in mild‐to‐moderate COVID‐19 patients revealed by colour Doppler ultrasound

“…Seven patients had just epididymitis (4.9%) being three of than with nonsevere COVID‐19 symptoms. Thirteen individuals had scrotum symptoms by the time of the US scanning (Chen, Huang, et al., 2020; Chen, Guo, et al., 2020). The present study enrolled just asymptomatic patients with mild‐to‐moderate COVID‐19 symptoms and found 42.3% of the patients with US signs of epididymitis.…”