Scrotal pyocoeles are typically a complication of epididymo-orchitis and 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 hydrocoele, 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 pyocoele on ultrasound are:
- complex, heterogeneous fluid collection in the scrotal sac with septa
- gas may be present causing hyperechoic foci and shadowing
If the pyocoele 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 pyocoele, however surgical debridement may be necessary in more severe cases.
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