Epididymal abscess

An epididymal abscess is an uncommon potential complication of epididymitis.

Pathology

Causative organisms are those that cause epididymitis and are.

• older individuals
  • Escherichia coli
  • Proteus mirabills
• younger individuals 
  • Chiamydia trachomatis
  • Neisseria gonorrhoeae
• Other rare aetiological agents
  • Streptococcus faecalls
  • Ureoplasma urealyticum
  • viral, spimochetal infections
  • Mycobacterium tuberculosis - rare - tuberculous epididymitis

Radiographic features

Ultrasound

Sonographic findings include

• scrotal wall thickening
• hyperaemic enlargement of the epididymis
• focal regions of decreased or mixed echogenicity
• non vascular hypoechoic area surrounded with hypervascular epididymis

Tuberculous epididymal abscesses tend to be larger in size while the degree of blood flow in the peripheral portion of the abscess can be comparatively lower.

Complications

Further complications that can result include

• rupture with focal testicular ischaemia or infarction
• inflammatory ulceration of the effenent  ductules or the ductus epididymis - may allow sperm to extravasate into the surrounding interstitium, inciting an
  intense inflammatory response that leads to sperm granuloma
  formation.