Chronic tuberculous epididymitis: color Doppler US findings with histopathologic correlation

Abstract

Color Doppler US may be helpful for differential diagnosis of tuberculous epididymitis and non-tuberculous epididymitis.

Imaging of the Epididymis

“…26,27 Hyperemia is seen with acute bacterial epididymitis, whereas focal linear or spotty blood flow signals may be seen in the peripheral zone of tuberculous epididymitis. 28 Sonographic findings in tuberculous orchitis are similar to those of tuberculous epididymitis. Other associated sonographic findings include thickened scrotal skin, hydrocele, intrascrotal extratesticular calcification, scrotal abscesses, and scrotal sinus tract.…”

Sonographic findings in tuberculous epididymo‐orchitis

“…7,16 On color Doppler sonography, nontuberculous epididymitis usually shows Doppler signals within the affected epididymis, whereas tuberculous epididymitis may show at most focal linear or spotty Doppler signals at the periphery of the epididymis. 24 Yang et al 29 found evidence that color Doppler signals were less numerous at the periphery of a tuberculous epididymal abscess than at the periphery of a pyogenic one.…”

“…4,9 Sonographically, tuberculous epididymitis appears as diffusely enlarged heterogeneously hypoechoic, diffusely enlarged homogeneously hypoechoic, or nodular enlarged heterogeneously hypoechoic lesions. 2,7,15,16,24 The sonographic heterogeneity may be accounted for by the presence of various pathologic components, including caseation necrosis, granulation tissues, and fibrosis. If a sinus draining necrotic pus exists, the lesion may have a more heterogeneous appearance, 2,7,16 as in the tail of the left epididymis in our case.…”

“…Skin thickening and a large volume of peritesticular fluid tend to indicate a nonneoplastic process. 2,7,24 Differentiating tuberculous epididymitis from nontuberculous epididymitis is important for disease management. Generally, the sonographic findings of nontuberculous epididymitis consist of diffuse enlargement of the epididymis and a uniform decrease in its echogenicity.…”

Tuberculosis of Male Genital System – Myth or Reality in 21st Century

“…It has been shown that TBC of the genital system may be present 20-30 years after primary localization [5,23]. In such cases, the source of infection might be existing primary focus in the lungs or lymph nodes, rare in bones, bowels or could be endogenous reinfection or exogenous superinfection [10,24].…”