Tuberculous Epididymo‐orchitis: Clinical and Ultrasound Observations

Abstract

The clinical, radiological and ultrasound features of 3 patients presenting with tuberculous epididymo-orchitis are described and the relevant literature reviewed. Scrotal swelling, pain and sinuses are common features at presentation. The presence of a sterile pyuria is a useful sign, but intravenous urography may fail to identify active renal disease. Ultrasound examination revealed testicular involvement in 2 patients. Differentiation from tumour may not be possible, but the presence of epididymal involvement strongly suggests an infective cause. Early surgical biopsy may prove helpful if acid-fast bacilli are not initially identified in early morning urine samples.

Diagnosis of isolated tuberculous orchitis by fine-needle aspiration cytology

“…4 The presence of abscess or scrotal sinus formation alerts the clinician toward a more aggressive disease process and testicular involvement should be seriously considered. 5,3 Our patient had a similar presentation. Such sinus tracts are known to occur as a result of caseous material reaching the scrotal skin; thus the chronic draining sinus should be regarded as having a tuberculous origin until proven otherwise.…”

Sonographic findings in tuberculous epididymo‐orchitis

“…4,7,25 The sonographic findings of tuberculous orchitis are similar to those for tuberculous epididymitis (diffuse enlargement of the testis with a homo-or heterogeneous hypoechoic texture or nodular enlargement of the testis with a heterogeneous hypoechoic texture). 2,7,15,16 Drudi et al 14 described multiple small, hypoechoic nodules in the enlarged testis as belonging to the miliary type and suggested that this sonographic pattern was a feature of tuberculous orchitis. This pattern was also found in 2 cases of tuberculous granuloma reported by Chung et al 7 Other sonographic features of scrotal tuberculosis include blurred separation between the testis and the epididymis, thickening of scrotal skin, hydrocele, and calcification of the epididymis and tunica vaginalis.…”

“…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.…”

“…7,15,17,18 Seventy percent of patients with tuberculous epididymitis have a previous history of tuberculosis. 6,17,19 Pulmonary and renal tuberculosis can respectively be documented in 50% and 80-85% of patients with genital tuberculosis.…”

Tuberculoma of the Spermatic Cord

“…Up to 70% of the patients with genitourinary TB have dormant or active pulmonary disease [8,9]. It is therefore incumbent on the treating doctor to rule out this possibility.…”