Sonographic findings in tuberculous epididymitis and epididymo-orchitis

Tuberculous epididymitis associated with abdominal lymphadenopathy (2004:1b)

“…In the early stages, the testis is usually spared. In the more advanced stages, testicular involvement caused by direct extension of a tuberculous abscess in the epididymis may be seen [3,4]; the latter may occur if therapy is not appropriate.…”

“…Most often, involvement of the scrotal contents is due to downward spread of renal tuberculosis and the consequent antegrade seeding of viable tubercle bacilli downstream. Epididymal involvement may occur after retrograde seeding of viable bacilli from the prostate or seminal vesicles via the vasal lumen itself or the perivasal lymphatics [4,5]. Unilateral or bilateral epididymal involvement may occur.…”

“…Ultrasound examination shows enlargement of the tail of the epididymis, which is diffusely hypoechoic, and thickening of the testicular sheaths. These US findings are, however, nonspecific, and differentiation between specific and nonspecific inflammation is not possible [4]. At a later stage, the inflammatory process usually involves both the head and tail of the epididymis, but not the body ("bipolar" form).…”

“…In these cases, US examination may show a diffusely enlarged and hypoechoic epididymis or a nodular "complex mass", hypoechoic with poor internal echoes and multiple septations. Thickening of the sheaths, especially the vaginal one, is usually seen and a characteristic hydrocele with septations may be present [3,4]. The marked sonographic heterogeneity may be explained by the variety of pathological components, including caseation necrosis, fibrosis, and granulation.…”

“…In more advanced cases, a chronic draining sinus resulting from caseous abscess formation may reach the scrotal skin. If present, this finding should be regarded as pathognomonic for a tuberculous origin until proven otherwise [4,8].…”