Scrotal tuberculosis

Last revised by Henry Knipe on 29 Sep 2022

Scrotal tuberculosis (TB) is a rare manifestation of extrapulmonary tuberculosis. It includes tuberculous orchitis and epididymitis.

Scrotal TB is rare representing only about 3% of cases of genitourinary tuberculosis 2.

Scrotal TB presents as a painless or slightly painful scrotal mass and so is difficult to differentiate from typical epididymo-orchitis or other conditions such as tumors or infarction 1

Infection usually affects the epididymis first and then can affect the testis if not treated. It is believed to occur due to a retrograde extension from the prostate and seminal vesicles as well as hematogenous spread 1.

Scrotal tuberculous typically begins in the tail of the epididymis and the ductus deferens.

Tuberculous epididymitis appears as a diffuse heterogeneous predominantly hypoechoic enlarged epididymis or an intrinsic focal nodular hypoechoic lesion. It usually shows increased color Doppler flow, differentiating it from infarction. Bilateral involvement is common, unlike other non-tuberculous infections.

Tuberculous orchitis is usually preceded or associated with epididymitis. Different sonographic patterns have been described 1:

  • diffusely enlarged heterogeneously hypoechoic testis
  • diffusely enlarged homogeneously hypoechoic testis
  • nodular enlarged heterogeneously hypoechoic testis
  • multiple small hypoechoic nodules in an enlarged testis (miliary type) 

Other associated findings:

Antituberculous chemotherapy is the mainstay of treatment. Orchiectomy is rarely required for diagnosis or treatment. It may result in infertility 3.

  • a heterogeneous, enlarged epididymis is more commonly seen with tuberculous rather than non-tuberculous epididymitis (which usually appears homogeneous)
  • bilateral involvement is more common with tuberculous epididymo-orchitis
  • failure of antibiotic therapy for epididymo-orchitis should raise suspicion for a tuberculous etiology
  • the presence of pulmonary or extrapulmonary tuberculosis infection elsewhere makes scrotal manifestations more likely to be tuberculous
  • associated features which are unusual in non-tuberculous epididymo-orchitis (such as intrascrotal extratesticular scrotal calcifications, scrotal abscess, and sinus tracts) are helpful clues

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Cases and figures

  • Case 1: tuberculous epididymitis and hydrocele
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  • Case 1: tuberculous orchitis
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  • Case 2: tuberculous orchitis
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  • Case 3: tuberculous epididymitis
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  • Case 4
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