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Pelvis » Scrotum And Testicles
Complicated acute epididymo-orchitis: with testicular infarct
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Author(s) :
P.K. Srivastava, MD
Presentation A 30 year old male presented with severe, acute pain in the left scrotum. A scrotal ultrasound was performed.
Caption: Sagittal image of the left scrotum
Description: The testis is normal in size, but appears to have a heterogeneous echotexture. It also demonstrates a few suspicious, poorly marginated, hypoechoic areas. An associated hydrocele is noted.
Caption: Sagittal image of testis and epididymis
Description: The hypoechoic area in the testis is better demonstrated in this image. The epididymis also appears enlarged and displays a heterogeneous echotexture.
Caption: Transverse power Doppler scan
Description: Markedly increased vascularity is noted in the left testis and the epididymis- suggestive of an inflammatory pathology. However, the hypoechoic area that was seen earlier on the gray scale image is seen to be completely devoid of color.
Caption: Sagittal power Doppler scan
Description: The area devoid of color is demonstrated again with the rest of the testis and epididymis exhibiting hyperemia. This is suggestive of testicular infarction in the setting of epididymo-orchitis.
Differential Diagnosis Left acute epididymo-orchitis with testicular infarct
Final Diagnosis Complicated left acute epididymo-orchitis with testicular infarct
Discussion Acute epididymo-orchitis and its associated complications has already been discussed in an earlier published case [click here to view].

This case has been illustrated here to demonstrate one of the most feared complications of this inflammatory pathology which is testicular ischemia and subsequent infarction.
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