Presentation
Nodularity at the base of the left scrotum. The patient had a similar episode 1 year ago for which an excision biopsy was performed showing chronic granulomatous infection, likely tuberculosis.
Patient Data
Enlarged heterogeneous, predominantly echogenic, appearance of epididymis primarily in the region of the tail with increased vascularity. The picture was confused with funiculitis, however in the latter pathology the thickening of the spermatic cord is present at the superior aspect of the testis, while in this case the thickening was at the base.
Case Discussion
Biopsy was done which showed a chronic granulomatous infection most likely tuberculous in etiology.
Tuberculous epididymitis is generally found in the tail of epididymis as it is most vascular and its closer proximity with the vas deferens increases secondary infection from urinary reflux.
Ultrasonography generally shows diffusely heterogeneous, predominantly hypoechoic, enlarged epididymis or a focal nodular hypoechoic lesion within it. Preferentially the tail is involved while the head is spared. The heterogeneity may be due to caseating necrosis, granulomas and/or fibrosis. A heterogeneous, enlarged epididymis favors tuberculous involvement over non-tuberculous involvement as it may show homogenous echotexture of enlarged epididymis. Increased color flow differentiates this condition from infarction. However tumor remains a possibility.
The variation, in this case, was the echogenicity. As it was hyperechoic rather than being hypoechoic, as is usually seen. As the patient had also had an excision biopsy 1 year previously of a similar nodule in this region, we attributed the varied appearance to post-procedural changes.
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