Goubaa Mohamed MD Djerba Tunisia

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This 14-year-old male patient has had right testicular pain and swelling for 2 days. An ultrasound examination was performed. Ce jeune de 14 ans et de sexe masculin avait des douleurs et un gonflement testiculaire depuis deux jours. Un examen échographique a été réalisé.


epididymis ultrasonography epididymitis

épididymite échographie épididyme

orchitis orchi-epididymitis ultrasound

echographie scrotum ultrasonography

goubaa image

Doppler testicle epididymis

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Sagittal gray-scale and power Doppler views show an enlarged head of the epididymis adjacent to the right testis. Marked hyperemia of the epididymis is evident on power Doppler and ultrasonography views of the epididymis show a slightly enlarged epididymis with intense hypervascularity on the color Doppler view. The findings are consistent with acute epididymitis. Les vues sagittales à l'échelle de gris et au Doppler couleur et de puissance montrent une tête épididymaire agrandie à côté du testicule droit. L'hyperhémie marquée de l'épididyme est évidente au Doppler et les images échographique de l'épididyme montrent un épididyme plus large que d'habitude avec une hyper-vascularisation intense au Doppler de couleur. Le diagnostic d'épididymite aigu est évident.




Acute epididymitis
Epididymite aiguë



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Epididymitis is the commonest intra-scrotal inflammation.
Epididymitis accounts for 75% to 80% of acute inflammatory disease of the scrotum. Swelling and sonographic epididymal abnormalities, skin thickening, and hydrocele are more suggestive of an infectious process than of tumor. Patients have pain for at least 2 days and may have a discharge.
Epididymitis may be acute or chronic and related to infection or trauma.
The most frequent cause of epididymitis is a bacterial infection (nonspecific germ : frequently the chlamydia or specific : gonorrhea or syphilis). This infection is usually from an urinary tract infection.

Ultrasonography :
Sonographic appearances are variable depending upon the stage and severity of the disease. The epididymus is usually enlarged and hypoechoic, but it may be intensely echogenic. Colour Doppler imaging shows hypervascularity within the epididymus.
In uncomplicated cases of epididymitis the testicle is usually not involved though there may be hypoechoic foci in the testicular parenchyme adjacent to the epididymus. With advanced epididymitis, small abscesses are occasionally seen as complex hypoechoic collections in the epididymis.
In chronic epididymitis, the epididymus is thickened and focally echogenic and may have calcifications.
In tuberculous epididymitis, the epididymus may become heterogeneous and hypoechoic associated with concomitant hypoechoic lesions in the testis and a discharging sinus. The testis may become stony hard associated with extra-testicular calcification.
Orchitis usually occurs in conjunction with epididymitis. Isolated orchitis is less common and generally is viral. Testicular enlargement, decreased echogenicity, and hypervascularity are ail typical findings As with epididymitis, 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.

Differential :
Sperm granulome.
Scrotal hernia.
Torsed appendix testis.
Benign solid tumors of the epididymus.
Fibrous pseudo-tumor of the epididymus.
Fournier's gangrene.
Lipoma or fibrolipoma of the spermatic cord.
Papillary cystadenoma of the epididymus.
Paratesticular rhabdomyosarcoma, leiomyosarcoma and other extratesticular malignant tumors.
Metastatic tumor of the tunica vaginalis.