Retroperiton

Orchitis

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Orchitis is defined as inflammation of the testis. Orchitis usually occurs in conjunction with epididymitis.
Bacterial orchitis is usually a secondary infection from epididymitis and may be a manifestation of a sexually transmitted disease, such as gonorrhea or chlamydia.
Isolated orchitis is less common and generally is viral (mumps). Viral causes of orchitis include mumps, influenza, and tonsillitis. Approximately 20% of prepubertal patients with mumps have orchitis develop. Orchitis develops in 15% to 25% of men with mumps after puberty.

Clinical :
Patients with orchitis may have pain, fever, nausea, and vomiting. If the disease is left untreated, areas of necrosis or abscess may develop.

Ultrasonography :
Testicular enlargement, decreased echogenicity, and hypervascularity are all typical findings. In the acute phase of orchitis, the testis or focal areas of the testis appear less echogenic than a normal testicle. Increased blood flow from hyperemia may be identified, and a reactive hydrocele may be present. Hypervascularity may be the only abnormal finding, so color Doppler analysis is more sensitive in the diagnosis of orchitis than is gray-scale sonography alone.
In the chronic phase, the testicle appears atrophied with degeneration of the tubules. The scrotal wall may be thickened with acute or chronic orchitis. In 60% of patients with orchitis, unilateral testicular atrophy occurs.

Differentials :
- Epididymitis.
- Hernias.
- Testicular Torsion.
- Trauma.
- Tumor: diffuse lymphoma or leukemia, and diffuse seminoma and it is difficult to distinguish a hypoechoic hypervascular tumor from focal orchitis.

Reference :
* 1 Tomita Y, Nemoto K. [A case of granulomatous orchitis] Hinyokika Kiyo. 2006 Oct;52(10):817-8.
* 2 Nikolic O, Lukac I. Doppler sonography in diagnosis of the acute scrotum. Med Pregl. 2006 Mar-Apr;59(3-4):111-7.
* 3 Feole JB, Lee FT Jr. Doppler sonography in testicular and scrotal imaging. Curr Opin Urol. 1998 Mar;8(2):87-94.
* 4 Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Hollwarth ME. Management of acute scrotum in children--the impact of Doppler ultrasound. J Pediatr Surg. 2006 Aug;41(8):1377-80.
* 5 Stuckmann G. [Ultrasound of the scrotum] Schweiz Rundsch Med Prax. 2006 May 3;95(18):709-20.
* 6 Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006 May;25(5):563-74.
* 7 Wittenberg AF, Tobias T, Rzeszotarski M, Minotti AJ. Sonography of the acute scrotum: the four T's of testicular imaging. Curr Probl Diagn Radiol. 2006 Jan-Feb;35(1):12-21.
* 8: Philip J, Selvan D, Desmond AD. Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility? BJU Int. 2006 Jan;97(1):138-41.