Vasitis

Last revised by Yuranga Weerakkody on 8 Aug 2023

Vasitis (plural: vasitides), also known as deferentitis (plural: deferentitides) or funiculitis 7, is an uncommon inflammatory disorder of the ductus (vas) deferens and spermatic cord. It is classified as either the generally asymptomatic vasitis nodosa (seen after vasectomy) or acutely painful infectious vasitis. This article refers to the acute infective form as imaging is usually not undertaken in the chronic form, with very sparsely described radiologic findings.

Funiculitis refers to inflammation of the spermatic cord (in TA it is called funiculus spermaticus 9). In general, cases that have historically been called funiculitis are really an inflammation of just the ductus deferens. Therefore it has been said that the latter term is preferable. Occasionally the inflammation may spread such that the entire spermatic cord is involved forming a true funiculitis 2,8.

Symptoms of acute vasitis are relatively non-specific and may include a painful swelling in the groin, symptoms of a urinary tract infection, or a dull ache in the pelvis. The infection may be severe with systemic signs of sepsis, and it may be misdiagnosed as other related acute urinary tract disorders such as epididymitis, orchitis, testicular torsion or prostatitis. It also mimics an acute inguinal hernia 2,3.

  • true funiculitis: see terminology section

The causative organism may be sexually transmitted infections such as Neisseria gonorrhea and Chlamydia spp., or a uropathogen such as Escherichia coli. Tuberculous vasitis has been described. Infections of the ductus deferens may be associated with epididymo-orchitis and prostatitis or may be primary. It may be associated with urogenital surgery such as vasectomy, prostatectomy and hernia repairs. 

Blood tests in vasitis usually show a leukocytosis. A urine culture may be negative.

Swelling of the inguinal canal with increased echogenicity of the fat may be seen. The region may appear hyperemic on color Doppler imaging, and there may be fluid within the canal. However, it is difficult to distinguish between an incarcerated inguinal hernia and vasitis using ultrasound alone 2-4.

Swelling of the inguinal canal with increased density of fat both within and adjacent to the inguinal canal is seen 2,3. There may be hyperenhancement of the spermatic cord, extending to involve the ductus deferens. An associated seminal vesicle abscess or seminal vesiculitis may be present, alongside a hydrocoele.

The edema of the inguinal canal and spermatic cord will be shown exquisitely on fluid-sensitive sequences 4.

Treatment is usually conservative with a course of oral antibiotics. Recovery is usually complete. No follow-up is required in uncomplicated cases. Surgical or radiologically guided drainage of abscesses may be required in severe cases.

Due to the presentation with a painful inguinal swelling, the differential includes an incarcerated inguinal or femoral hernia. Imaging finding of a tubular structure within the inguinal canal in the setting of an acute presentation and a history of an orchiectomy may lead to a misdiagnosis of an Amyand hernia. This is postulated to occur due to distension of the ductus deferens following an orchiectomy 5.

Making a positive diagnosis of vasitis enables conservative management to be followed and avoids unnecessary surgery. Ultrasound may exclude mimics such as epidydmo-orchitis, but CT will be helpful in differentiating an acute inguinal hernia from vasitis. If MRI is available, it is the preferred modality as it avoids radiation and depicts the inflammatory changes very well.

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