Scrotal pyoceles are typically a complication of epididymo-orchitis or testicular abscess but can also occur following trauma or surgery. The purulent fluid collection generally arises from communication between the infected testicle or testicular abscess and an existing hydrocele, through the mesothelial lining of the tunica vaginalis.
Ultrasound is the imaging modality of choice for investigation of scrotal pain and swelling, or follow-up of a known epididymo-orchitis. Features of pyocele on ultrasound are:
- complex, heterogeneous fluid collection in the scrotal sac with septa
- gas may be present causing hyperechoic foci and shadowing
If the pyocele organises into a scrotal abscess, there will be a distinct well-demarcated hyperaemic wall around the purulent fluid collection.
Treatment and prognosis
Conservative management with antibiotics is generally sufficient for treatment of a pyocele, however surgical debridement may be necessary in more severe cases.
- 1. Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 2003;23 (1): 215-40. Radiographics (full text) - doi:10.1148/rg.231025133 - Pubmed citation
- 2. Garriga V, Serrano A, Marin A et-al. US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. Radiographics. 2009;29 (7): 2017-32. Radiographics (full text) - doi:10.1148/rg.297095040 - Pubmed citation
- 3. Resende D, Souza L, Monteiro I et-al. Scrotal collections: pictorial essay correlating sonographic with magnetic resonance imaging findings. Radiologia Brasileira.47 (1): 43-48. doi:10.1590/S0100-39842014000100014