Tuberculous epididymitis generally occurs in the tail of epididymis
as it is most vascular and its relation with the vas deferens to be involved
with urinary reflux. USG generally shows diffuse heterogenous predominantly
hypoechoic enlarged epididymis or focal nodular hypoechoic lesion within it.
Preferentially the tail is involved while the head is spared. The heterogeneity could
be due to caseating necrosis, granulomas and fibrosis. A heterogenous, enlarged
epididymis favours tuberculous involvement than non tuberculous involvement as
it may show homogenous echotexture of enlarged epididymis. Increased colour
flow differentiate this condition from infarction. However, tumour can still be
The variation in this case was the echogenicity. As it was hyperechoic
rather than being hypoechoic as seen in usual cases. As patient had also done excision biopsy 1
year back of similar nodule in this region, we attribute it to post procedure
changes. However it should be further studied in detail.