Testicular infarction due to epididymitis

Case contributed by Dr Alborz Jahangiri

Presentation

Epididymitis which did not respond to IV antibiotics.

Patient Data

Age: 25
Gender: Male
Ultrasound

Initial ultrasound exam

Patient underwent colour Doppler ultrasonography of the testicles that showed increased vascularity and increased resistive index of the right testicle, with gross enlargement of the right testicle.

The ultrasound findings were suggestive of epididymo-orchits.

Pathology

Follow up ultrasound exam (six days later)

Follow up ultrasound exam shows no flow in the right testicle with colour Doppler imaging.

Photo

Gross pathology and histopathology

  • pathology exam showed extensive necrosis with acute on chronic inflammation and some haemorrhage and fibrosis involving epididymis and spermatic cord and the right testicle
  • patient underwent scrotal exploration, which revealed a necrotic right testicle and epididymitis

Case Discussion

Testicular ischaemia secondary to non responding epididymitis to antibiotics is rare.

Colour flow Doppler ultrasound is required to asses the involved testicle in patients with epididymitis who responded initially to antibiotics treatment and later developed pain and tenderness and fevers during the course of treatment.

In this case, no flow was detected six days after initial antibiotic therapy and patient had ongoing pain, tenderness and febrile episodes while on broad spectrum IV antibiotics.

Surgical exploration and orchidectomy was performed after colour flow Doppler ultrasound showed no flow in the affected testicle.

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Case information

rID: 38845
Case created: 7th Aug 2015
Last edited: 17th Jun 2017
System: Urogenital
Inclusion in quiz mode: Included

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