Presentation
Acute onset right Hemi-scrotal pain, negative trauma. Request to exclude torsion.
Patient Data
Ultrasound confirmed normal bilateral testicular volume and sonographic appearance. There is no testicular torsion with normal duplex doppler flow. There is a tiny, simple, right hydrocoele. There are no varicoceles bilaterally. There is an incidental focal speckled appearance to the right epididymal head suggesting epididymal head tubular ectasia. There is a consequent bulky right epididymal head. There is also an incidental tiny right epididymal head cyst (possibly tiny spermatocele).
Annotated ultrasound images depicting the focal tubular ectasia within the right epididymal head.
Case Discussion
Tubular ectasia of the rete testis and epididymis is usually found in adult patients and especially after a vasectomy (extratesticular ductus deferens obstruction). Other extratesticular causes of ductus deferens obstruction include post-abdominal and pelvic surgeries including hernia repairs and rectal malignancy surgery. It may be found in patients on dialysis for chronic renal failure, possibly due to the retention of calcium oxalate crystals. It can also be seen in patients with hydroceles. Intratesticular obstruction is usually due to previous inflammatory insult occurring in orchitis or epididymo-orchitis. Tubular ectasia is often seen with a spermatocele.
In this unusual pediatric presentation, tubular ectasia was only present in the right epididymal head and of uncertain exact etiology, possibly due to a previous infection.
The multiple cystic interfaces between the walls of dilated ductules and fluid produce the unique speckled appearance often identified on scrotal ultrasound.