Testicular infarction due to epididymitis

Case contributed by Alborz Jahangiri
Diagnosis certain

Presentation

Epididymitis which did not respond to IV antibiotics

Patient Data

Age: 25 years
Gender: Male

Initial ultrasound

ultrasound

Patient underwent color Doppler ultrasonography of the testes that showed increased vascularity and increased resistive index of the right testis, with gross enlargement of the right testis.

The ultrasound findings were suggestive of epididymo-orchitis.

FU US 6 days later

pathology

Follow up ultrasound exam shows no flow in the right testis with color Doppler imaging.

Gross path & histopathology

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

Case Discussion

Testicular ischemia secondary to non-responding epididymitis to antibiotics is rare.

Color flow Doppler ultrasound is required to assess the involved testis in patients with epididymitis who respond initially to antibiotics and later develop pain, 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 orchiectomy were performed after color flow Doppler ultrasound showed no flow in the affected testis.

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