Presentation
Past medical history of epididymitis and type II diabetes mellitus. Two-day history of progressively worsening left scrotal pain and swelling. Examination: left scrotal erythema and tenderness.
Patient Data
Prior admission: right scrotum
Normal Doppler flow is present in the right testicle. Small right hydrocele, without septation.
Right testicle is normal in appearance. Normal flow is seen within the right testicle. The right epididymis also appears normal.
Prior admission: left scrotum
The left epididymis demonstrates hyperaemia and enlargement relative to the contralateral side. There is a moderate-volume complex hydrocele, with multiple loculations and associated scrotal thickening (not shown).
No colour or spectral Doppler flow is seen in the left testicle. There is peripheral hypervascularity involving the left scrotal sac. The left testicle has a heterogeneous abnormal appearance. No discrete fluid collection is seen, but there is substantial left scrotal wall oedema. The left epididymis is enlarged and hyperaemic.
Surgical pathology exam:
Left testicle, partial orchidectomy: infarcted and necrotic testis with acute and chronic inflammation and abscess, involving overlying subcutis. Negative for malignancy. Viable spermatic cord margin.
Case Discussion
Ultrasound with colour flow Doppler is the primary method to diagnose testicular infarction secondary to epididymitis. Characteristics of testicular infarction include asymmetrically decreased or absent intrinsic testicular blood flow with or without increased peripheral flow. Testicular infarction is a rare but important diagnosis to consider in the setting of epididymitis that has management implications to prevent morbidity.
Authors: Manoj Ravichandran, Yumna Furqan, Luke Eldore, Hamza Malick, Trevor Borries, MD, Kiera Mason, MD Gregory dePrisco, MD