A better understanding of testicular and/or epididymal tuberculosis based on clinical, ultrasonic, computed tomography, and magnetic resonance imaging features at a high-volume institute in the modern era

Abstract

Background: There is a concerning underdiagnosis of testicular and/or epididymal tuberculosis (TB).A lack of clinician awareness has led to many patients undergoing unnecessary surgeries. The purpose of this series was to enhance understanding of testicular and/or epididymal TB based on clinical, ultrasonic, computed tomography (CT), and magnetic resonance imaging (MRI) features from the past decade.Methods: We retrospectively investigated the medical records of 69 patients diagnosed with testicular and/ or epididymal TB from 2008 to 2019. All participants were diagnosed by confirmation of Mycobacterium tuberculosis in the histopathology of resected samples. Baseline characteristics, ultrasonic, CT, and MRI features were collected for analysis.Results: A total of 69 patients with a median age of 43.5 years were included in the study. Testicularepididymis TB, epididymal TB, and testicular TB were confirmed in 31 (44.9%), 26 (37.7%), and 12 (17.4%) patients, respectively. In sonography, testicular TB and epididymal TB imaging features are significantly different (P<0.001). Diffusely enlarged lesion heterogeneously (33/58, 56.9%) is most common in the epididymis, and miliary type (18/39, 46.2%) is most common in the testis. On enhanced CT, annular or multilocular enhancement pattern (19/21, 90.5%) was the characteristic manifestation of our patients. Conclusions: Laboratory findings [especially T lymphocyte spot test for tuberculosis infection (T-SPOT.TB)], accompanied by scrotal sonography and enhanced CT examinations, can help distinguish testicular and/or epididymal TB from other etiologies.

Machine Learning Assisted Doppler Features for Enhancing Thyroid Cancer Diagnosis

“…This was the first study to calculate the number of vessels in a full objective way. In previous studies, semiquantitative methods such as Adler's classification 5 were widely adopted in visually counting the number of vessels in breast nodules, 30 solid renal tumors, 4 soft tissue tumors, 31 cervical cancer, 32 and TNs 33 . Xia et al 33 adopted Alder's classification to divide the number of vascularity in TNs into four categories, namely, grade 0 (no blood vessel), grade I (low blood flow with rod‐like blood flows), grade II (medium blood flow with 3–4 blood vessels and at least one blood vessel are longer than the radius of the nodule), and grade III (rich blood flow with >4 blood flow signals).…”

Imaging findings in inflammatory disease of the genital organs

“…Low signal intensity on T2-weighted images is typically associated with fibrosis, with more acute orchitis showing T2 hyperintensity. Contrast enhancement can range from no enhancement to homogeneous enhancement, with some cases showing ill-defined heterogeneous enhancement with an annular or multilocular pattern [ 18 , 32 ]. Testicular and epididymal TB can present with or without an associated hydrocele, scrotal skin thickening, intra-scrotal extratesticular calcification, or scrotal abscess [ 32 ].…”

Mistakes in the diagnosis of tuberculous orchiepididymitis.

“…5. Testicular ultrasound showed an enlarged heterogeneous hyperemic right epididymis with hypoechogenicity in the tail of the epididymis, concerning for a developing abscess [58] очаги в органах мошонки [19]. УЗИ мошонки при туберкулезе скротальных органов может выявить утолщение кожи мошонки, нечеткое разделение между яичком и его придатком, гидроцеле и имбибирование солями кальция тканей придатка яичка и вагинальной оболочки [44][45][46].…”

“…У 17,4% больных обнаружили изолированный туберкулез яичка, что ортодоксальная фтизиоурология отрицает в принципе. Во всех случаях M. tuberculosis была идентифицирована в операционном материале [19]. R. Madeb и соавт.…”