Epididymal abscess

An epididymal abscess is an uncommon complication of epididymitis.

Pathology

Causative organisms are the same that cause epididymitis:

• older individuals
  • Escherichia coli
  • Proteus mirabills
• younger individuals 
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
• Other rare aetiological agents
  • Streptococcus faecalls
  • Ureoplasma urealyticum
  • viral, spirochete infections
  • Mycobacterium tuberculosis (tuberculous epididymitis)

Radiographic features

Ultrasound

Sonographic findings include

• scrotal wall thickening
• hyperaemic enlargement of the epididymis
• focal regions of decreased or mixed echogenicity
• nonvascular 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.

Treatment and prognosis

Complications

Further possible complications from an epididymal abscess

• rupture with focal testicular ischaemia or infarction
• inflammatory ulceration of the efferent 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.