Revision 8 for 'Testicular infarction due to epididymitis'All Revisions
Testicular Infarction due to Epididymitis
Testicular infarction secondary to unremitting epididymitis is a rare condition, which is infrequently recognized and rarely diagnosed in time to save the involved testes . Cases of testicular infarction after epididymitis have been reported previously in the literature [2,4-7]. However, the true incidence is not yet known and may be underestimated.
Four contributing factors have been explained previously to cause testicular infarction secondary to epididymitis. 1) Venous outflow obstruction due to edema of the epididymis is believed to be a cause for this complication which was what had happened in our case .2) irreversible spermatic vascular obstruction due to inflammation of the spermatic cord (Funiculitis) .3) Vascular compression at the external inguinal ring  .4) Endothelial damage and vascular thrombus due to bacterial toxins .
Color flow Doppler Ultrasonography is the key to evaluate patients with acute testicular ischemia furthermore it may allow differentiation between testicular torsion and epididymitis. It is also used to rule out the underlying pathologies like malignancies and abscess.
The hypoperfused testicle in epididymitis has decreased blood flow to the testicle with increased blood flow to the scrotum while global decrease in testicular blood flow is suggestive of a torsion . This has important implication since many patients who are eventually explored after a non-resolving epididymo-orchitis and are found to have a necrotic testicle may be mistakenly given the diagnosis of missed torsion .
Color flow Doppler should be considered in patients with severe unresolving epididymitis despite appropriate conservative treatment and also sudden onset of testicular pain developing in patients who initially responded well to antibiotics . Repeated febrile episodes  and tenderness and palpable thickening of the spermatic cord during the treatment of acute epididymitis and epididymitis in patients with recurrent episodes of acute epididymitis should also warrant a Color flow Doppler Ultrasonography [3,7].