Tuberculous epididymo-orchitis: the role of ultrasound

Wallage, Iraida; Riley, Sara J.

doi:10.1258/ult.2010.010021

Cited by 3 publications

(10 citation statements)

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“…Drudiet al 9 also described another pattern of multiple small hypoechoic nodules (Figs.2B, 4B) in the enlarged testis as a miliary type and suggested that this pattern was a feature of tuberculosis Orchitis. Miliary pattern was also found in two of 18 patients in the series of Chung et al study 11,12 .On Colour Doppler ultrasound examination of TB nodule showslinear peripheral increased vascularity with no abnormal flow in the centre (Fig.3A)which is well correlate with pathological findings that central portion shows, caseation necrosis, and the peripheral portion shows several medium to small sized vessels 1,13 which may help to differentiate TB nodules from other lesions 6 . Bilateral involvement of epididymides is seen in about 25% of patients, 12 and coarse calcifications also favor the diagnosis of a chronic tuberculous infection 2 .…”

Section: Methodsmentioning

confidence: 56%

“…The sonographic appearances in patients with tuberculous epididymitis are seen to be different from those encountered in nontuberculous epididymitis. GUTB is the most common extrapulmonary manifestation after lymphatic TB, representing 2-4% of all cases of tuberculosis and 15% of all non-pulmonary manifestations 3,6 . Genitourinary system involvement has been observed in 20% of pulmonary TB cases.…”

Section: Methodsmentioning

confidence: 99%

“…With both hematogenous and direct spread, the epididymal tail is the first structure to be involved, 2,8,9 as it has the rich blood supply and also the first part to be involved in urinary reflux 2 . The inflammatory process may propagate to the rest of the epididymis and finally to the ipsilateral testis or may regress and heal with calcifications 6 . Isolated TB orchitis without epididymitis is very rare 3,7,10 .…”

Section: Methodsmentioning

confidence: 99%

“…Ziehl-Neelsen (ZN) stain performed on the slides confirms the presence of numerous acid-fast bacilli 4 . Sonographic patterns of tuberculosis in the scrotum are varied and dependent on the stage of the disease 6 . Sonographic Appearances of Tuberculosis Epididymitis:Different sonographic echogenic patterns of tuberculosis epididymitis include: (a) Enlarged, hypoechoic and diffusely homogeneous (Figs.1A, 2A); (b) enlarged, hypoechoic and diffusely heterogeneous (Fig.1C); and (c) enlarged, nodular, heterogeneous and hypoechoic (Figs.3A, 4A).…”

Section: Methodsmentioning

confidence: 99%

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2018

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Objective: To determine the Ultrasonographic appearances in patients with tuberculous Epididymo-Orchitis and Orchitis and to correlate them with the histopathological findings. Materials and Methods: Total 25patients with 50 hemi scrotums of clinically suspected Epididymo-Orchitis and Orchitis with high suspicion of tubercular aetiology were assessed on ultrasonography. Of these 50 hemi scrotums, 12 scrotums of 8 patients testicular and epididymal tissues cultures were positive for Mycobacterium tuberculosis. Results: The most detected sonographic findings of tuberculous epididymitis were an enlarged epididymis commonly in the tail region, and marked heterogenous echo texture of the involved epididymis. Sonographic findings of testicular involvement consist of an ill defined focal intratesticular hypoechoic area or diffusely enlarged hypoechoic testis or an irregular margin between the testis and epididymis. In our study Unilateral Epididymo-Orchitis is the most common involvement pattern followed by isolated epididymitis, bilateral Epididymo-Orchitis and isolated orchitis respectively. The sonographic appearances in patients with tuberculous epididymitis are seen to be different from those encountered in nontuberculous epididymitis. Conclusion: Adequate evaluation of patients with high suspicion of Tuberculous Epididymo-Orchitis and Orchitis, by means of scrotal ultrasound coupled with fine needle aspiration cytology is critical to diagnostic accuracy and optimal treatment. Ultrasound significantly helpful to the initial assessment and future management of the patient with follow-up scans ensuring positive response to treatment thereby avoiding surgical intervention.

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Section: Methodsmentioning

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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2018

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“…Patients suspected of EPTB may present with clinical signs and symptoms of a scrotal swelling with or without pain, mass, and a discharging scrotal sinus. 5 The inflammatory process may either revert to an early state of the disease and heal, often with calcifications, or spread to the rest of the epididymis and eventually to the ipsilateral testis. 5 The normal testis has uniform mid-gray or mediumlevel echoes.…”

Section: Discussionmentioning

confidence: 99%

Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis

Mahaveer

Weston

Wolstenhulme

2017

Journal of Diagnostic Medical Sonography

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A male patient was referred to radiology with scrotal pain and swelling. Prior to diagnosis, the patient had three sonograms for scrotal swelling, which progressed to a discharging scrotal sinus. At the second scan, a risk factor of past history of pulmonary tuberculosis (PTB) was noted. The first sonogram showed findings suggestive of left epididymitis, the second sonogram showed possible primary testicular tumor or epididymal tuberculosis (EPTB), the third sonogram showed epididymal pathology extending to involve the tunica vaginalis and scrotal wall leading to a sinus tract formation, and the fourth sonogram was normal. This case highlights the sonographic findings during progression of EPTB and the differential diagnosis to consider in such cases. It is a useful educational aid for radiologists and sonographers when evaluating the role of sonography in the management of a patient with scrotal swelling and discharging scrotal sinus.

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Isolated Tubercular Epididymitis: A 10-Year Series

Rai,

Jogula,

Nerli

et al. 2024

STMJ

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Introduction: Genitourinary tuberculosis (TB) is considered a common form of extrapulmonary TB, being second only to lymph node tuberculosis, which is the most common site. Isolated TB of the epididymis is rare, and diagnosis of epididymal TB can be challenging. In this study, we report our series of isolated TB of the epididymis. Materials & Methods: We retrospectively collected the outpatient and inpatient records of histologically confirmed epididymal tuberculosis. Data including age, clinical presentation, examination findings, and diagnostic tests were reviewed and analyzed. Results: A total of 56 patients were diagnosed to have isolated tuberculosis of the epididymis during the 10-year study period. The mean age was 33 years. The clinical presentation included a hard nodule in the epididymis (100%), hydrocele in 16 (28.5%), posterior scrotal sinus in 6 (10.7%), and sensitivity in 14 (25%) and fever in 3 (5.3%). Four (7.1%) patients had bilateral epididymal nodules, 30 (53.5%) had left-sided, and 22 (39.2%) had right-sided involvement. Scrotal exploration and epididymal biopsy were performed in 16 (28.5%), and unilateral epididymectomy was performed in 40 (71.4%). The histopathological examination revealed a typical tubercular granuloma in all these patients. All patients were put on anti-TB drugs. Conclusions: Isolated TB of the epididymis is a rare disease. Treatment with anti-TB drugs remains the first-line intervention in all cases. Surgery is indicated in cases of failure of pharmacological treatment or the development of complications.

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Tuberculous epididymo-orchitis: the role of ultrasound

Cited by 3 publications

References 6 publications

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Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis

Isolated Tubercular Epididymitis: A 10-Year Series

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