Epididymitis
Updates to Article Attributes
Epididymitis refers to inflammation of the epididymis, and may be associated with inflammation extending to the testis itself, in which case the term epididymo-orchitis is used. This should be distinguished from isolated orchitis, which is by comparison much less common.
Epidemiology
There are two peaks of prevalence: <2 years of age and >6 years of age.
Clinical presentation
The clinical spectrum ranges from mild tenderness to a severe febrile process with acute unilateral scrotal pain.
Pathology
The infection usually originates in the bladder or prostate gland, spreads through the vasductus deferens and the lymphatics of the spermatic cord to the epididymis, and finally reaches the testis, causing epididymo-orchitis.
Radiographic features
Ultrasound
The epididymal head is the most affected region, and reactive hydrocoele and wall thickening are frequently present.
Increased size and, depending on the time of evolution, decreased, increased, or heterogeneous echogenicity of the affected organ are usually observed.
The inflammation produces increased blood flow within the epididymis, testis, or both.
Analysis of the epididymal waveform may reveal a low-resistance pattern as compared with the normal pattern.
Nuclear medicine
Pertechnetate scintigraphy can be used in evaluating the acute scrotum. Increased perfusion and uptake of the scrotal contents is characteristic of epididymo-orchitis. In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymus.
Treatment and prognosis
Complications
Complications of epididymo-orchitis include:
- vascular compromise due to increased intratesticular pressure resulting in testicular ischaemia and even infarction
- epididymal abscess
- testicular abscess
Differential diagnosis
Differential considerations include
- isolated orchitis
- granulomatous epididymitis
- chronic epididymitis: enlarged epididymis with increased heterogeneous echogenicity
- testicular neoplasm: clinical presentation is usually different
-<p><strong>Epididymitis </strong>refers to inflammation of the <a href="/articles/epididymis">epididymis</a>, and may be associated with inflammation extending to the <a href="/articles/testes">testis</a> itself, in which case the term <strong>epididymo-orchitis </strong>is used. This should be distinguished from isolated <a href="/articles/orchitis">orchitis</a>, which is by comparison much less common. </p><h4>Epidemiology</h4><p>There are two peaks of prevalence: <2 years of age and >6 years of age.</p><h4>Clinical presentation</h4><p>The clinical spectrum ranges from mild tenderness to a severe febrile process with acute unilateral scrotal pain. </p><h4>Pathology</h4><p>The infection usually originates in the <a href="/articles/urinary-bladder">bladder</a> or <a href="/articles/prostate">prostate gland</a>, spreads through the <a href="/articles/ductus-deferens">vas deferens</a> and the lymphatics of the spermatic cord to the epididymis, and finally reaches the testis, causing epididymo-orchitis.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The epididymal head is the most affected region, and reactive <a href="/articles/hydrocoele-1">hydrocoele</a> and wall thickening are frequently present.</p><p>Increased size and, depending on the time of evolution, decreased, increased, or heterogeneous echogenicity of the affected organ are usually observed.</p><p>The inflammation produces increased blood flow within the epididymis, testis, or both.</p><p>Analysis of the epididymal waveform may reveal a low-resistance pattern as compared with the normal pattern.</p><h5>Nuclear medicine</h5><p>Pertechnetate scintigraphy can be used in evaluating the acute scrotum. Increased perfusion and uptake of the scrotal contents is characteristic of epididymo-orchitis. In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymus. </p><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Complications of epididymo-orchitis include:</p><ul>- +<p><strong>Epididymitis </strong>refers to inflammation of the <a href="/articles/epididymis">epididymis</a>, and may be associated with inflammation extending to the <a href="/articles/testes">testis</a> itself, in which case the term <strong>epididymo-orchitis </strong>is used. This should be distinguished from isolated <a href="/articles/orchitis">orchitis</a>, which is by comparison much less common. </p><h4>Epidemiology</h4><p>There are two peaks of prevalence: <2 years of age and >6 years of age.</p><h4>Clinical presentation</h4><p>The clinical spectrum ranges from mild tenderness to a severe febrile process with acute unilateral scrotal pain. </p><h4>Pathology</h4><p>The infection usually originates in the <a href="/articles/urinary-bladder">bladder</a> or <a href="/articles/prostate">prostate gland</a>, spreads through the <a href="/articles/ductus-deferens">ductus deferens</a> and the lymphatics of the <a title="Spermatic cord" href="/articles/spermatic-cord">spermatic cord</a> to the epididymis, and finally reaches the testis, causing epididymo-orchitis.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The epididymal head is the most affected region, and reactive <a href="/articles/hydrocoele-1">hydrocoele</a> and wall thickening are frequently present.</p><p>Increased size and, depending on the time of evolution, decreased, increased, or heterogeneous echogenicity of the affected organ are usually observed.</p><p>The inflammation produces increased blood flow within the epididymis, testis, or both.</p><p>Analysis of the epididymal waveform may reveal a low-resistance pattern as compared with the normal pattern.</p><h5>Nuclear medicine</h5><p>Pertechnetate scintigraphy can be used in evaluating the acute scrotum. Increased perfusion and uptake of the scrotal contents is characteristic of epididymo-orchitis. In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymus. </p><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Complications of epididymo-orchitis include:</p><ul>
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