Scrotal pyocele

Last revised by Dr Calum Worsley on 02 Sep 2021

Scrotal pyoceles are purulent fluid collections in the scrotal sac, that generally occur in conjunction with epididymo-orchitis.

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 testis 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 organizes into a scrotal abscess, there will be a distinct well-demarcated hyperemic wall around the purulent fluid collection.

Conservative management with antibiotics is generally sufficient for treatment of a pyocele, however surgical debridement may be necessary in more severe cases.

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Cases and figures

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