Type:
Educational Exhibit
Keywords:
Abdomen, Genital / Reproductive system male, Ultrasound, Ultrasound-Colour Doppler, Other, Inflammation
Authors:
A. Lanyon, B. Di Muzio, N. Khominsky
DOI:
10.26044/ranzcr2023/C-280
Background
Case 1
A 27-year-old male presented with a history of dysuria and left testicular pain, redness and swelling, blood in ejaculate, having unprotected intercourse one week prior. He was clinically diagnosed with epididymo-orchitis and commenced on antibiotic therapy. He represented two days later with no improvement of symptoms. Ultrasound (US) at the time showed only features of non-complicated epididymitis. He was discharged home with a course of antibiotics. One month later, the patient represented with recurrence of his symptoms. Ultrasound then showed an enlarged left testis (35 ml) with heterogeneous echotexture and increased vascularity (Figure 1). The left epididymis was enlarged and had increased vascular flow and there was also a small complex hydrocele. Conservative management with antibiotics was offered. Due to ongoing pain and raised inflammatory markers a repeat US was performed 5 days later, revealing similar enlarged left testicle, now diffusely hypoechoic and hypovascular. A new 4ml hypoechoic shadowing focus in the left testicular was compatible with a gas containing abscess. Again the patient was managed conservatively and discharged home. Repeat outpatient US two weeks later showed an enlarged heterogeneous and completely avascular left testis with a gas containing abscess still present (Figure 2). An orchiectomy was performed. Histology performed showed features factoring necrotising pyogenic bacterial orchitis with secondary testicular infarct.
Case 2
A 50-year-old male presented to emergency with a two-day history of right-sided testicular pain, dysuria, and haematuria, previously having a left-sided epididymo-orchitis as well as HIV and psoriasis. Blood cultures showed an E. Coli bacteremia. He was commenced on IV antibiotic therapy. US study done on admission showed enlarged right testis with diffusely increased vascularity but normal homogeneous echotexture. The right epididymis was enlarged with increased vascularity throughout. A small right-sided simple hydrocele was noted (Figure 3). Due to ongoing fevers and rising inflammatory markers, a repeat US was performed 5 days later. This showed enlarged right tests with no colour flow as well as an enlarged epididymis with increased vascularity. A right-sided orchiectomy was then performed.
Case 3
A 72-year-old male who presented to emergency with a 2 days history of right testicular pain and swelling, associated with poor urination, hot and cold sweats, vomiting and coryzal symptoms. Bedside point of care ultrasound showed a swollen and tender right testes. It was unclear if doppler studies were performed. Sonographer US on the following day showed an enlarged right testicle with the absence of flow on doppler studies. There were also features of subacute/chronic inflammation within the right hemiscrotum characterised by a small septated hydrocele and thickened scrotal wall. The epididymis on the right was hyperemic and slightly oedematous (Figure 4). Orchiectomy showed nonviable testis with histology confirming Epididymo Orchitis with florid acute inflammation, necrosis and secondary haemorrhage.