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Imaging in emphysematous epididymo-orchitis: A rare cause of acute scrotum.

Mandava A, Rao RP, Kumar DA, Naga Prasad IS - Indian J Radiol Imaging (2014)

Bottom Line: Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue.Patient presents with fever, acute pain, swelling and tenderness in the scrotum.Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Central Hospital, Lalaguda, South Central Railway, Secunderabad, Andhra Pradesh, India.

ABSTRACT
Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue. Patient presents with fever, acute pain, swelling and tenderness in the scrotum. Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion. We report a case of emphysematous epididymo-orchitis with imaging findings on plain radiography, ultrasound, CT and MRI and a brief review of the literature.

No MeSH data available.


Related in: MedlinePlus

Coronal T1W, coronal fat suppressed (STIR), coronal T2W and sagittal T2W MRI images show air in the right testis, epididymis and scrotal wall that is hypointense on all sequences. The hyperintense septa in right testis, peritesticular collection, thickened scrotal wall and normal left testis are also visualised
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Figure 5: Coronal T1W, coronal fat suppressed (STIR), coronal T2W and sagittal T2W MRI images show air in the right testis, epididymis and scrotal wall that is hypointense on all sequences. The hyperintense septa in right testis, peritesticular collection, thickened scrotal wall and normal left testis are also visualised

Mentions: General physical examination demonstrated an elevated temperature of 101°F and tachycardia. Blood pressure and other vital signs were normal. Initial investigations revealed a random blood sugar of 155 mg/dl, glycosylated hemoglobin of 7.4, leucocyte (WBC) count of 14,800, and a normal serum urea, creatinine and electrolytes. Blood and urine cultures were negative. Clinical examination showed enlarged, inflamed scrotum with erythema of skin overlying the scrotum. Palpation revealed an enlarged, tender right testis and the epididymis was not separately palpable. An abdominal USG (My-LabTM 60 (Esaote, Genoa, Italy) was normal. USG of the scrotum revealed enlarged, ill-defined, hypoechoic right testis and epididymis with multiple linear and punctate bright, highly reflective hyperechoic foci suggestive of gas shadows [Figure 1]. The wall of the scrotal sac also showed linear highly reflective hyperechoic gas shadows on the right side. Left testis was normal and colour Doppler of right testis showed absence of normal testicular parenchymal vascularity [Figure 2]. A plain radiograph of the scrotum showed pockets of radiolucent areas within the soft tissues of the scrotum [Figure 3]. CT (Siemens SOMATOM Definition, Germany) and MRI (GE Signa HDx 1.5T MRI, USA) of the abdomen/pelvis and scrotum were obtained to confirm the diagnosis, see the extent of involvement and exclude Fournier's gangrene. CT demonstrated a multi-loculated collection of gas with thin septa in the right testis and epididymis with air fluid levels in the scrotal wall [Figure 4]. MRI of the pelvis and scrotum revealed intraparenchymal air that was hypointense on all sequences in the testis, epididymis and scrotal wall along with the hyperintense septa in right testis, peritesticular collection and thickened scrotal wall [Figure 5]. A diagnosis of right emphysematous epididymo-orchitis with cellulitis of scrotal wall was made and the patient was given intravenous antibiotics and taken up for surgery. Right orchidectomy was performed with surgical debridement and the patient made an uneventful postoperative recovery.


Imaging in emphysematous epididymo-orchitis: A rare cause of acute scrotum.

Mandava A, Rao RP, Kumar DA, Naga Prasad IS - Indian J Radiol Imaging (2014)

Coronal T1W, coronal fat suppressed (STIR), coronal T2W and sagittal T2W MRI images show air in the right testis, epididymis and scrotal wall that is hypointense on all sequences. The hyperintense septa in right testis, peritesticular collection, thickened scrotal wall and normal left testis are also visualised
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126149&req=5

Figure 5: Coronal T1W, coronal fat suppressed (STIR), coronal T2W and sagittal T2W MRI images show air in the right testis, epididymis and scrotal wall that is hypointense on all sequences. The hyperintense septa in right testis, peritesticular collection, thickened scrotal wall and normal left testis are also visualised
Mentions: General physical examination demonstrated an elevated temperature of 101°F and tachycardia. Blood pressure and other vital signs were normal. Initial investigations revealed a random blood sugar of 155 mg/dl, glycosylated hemoglobin of 7.4, leucocyte (WBC) count of 14,800, and a normal serum urea, creatinine and electrolytes. Blood and urine cultures were negative. Clinical examination showed enlarged, inflamed scrotum with erythema of skin overlying the scrotum. Palpation revealed an enlarged, tender right testis and the epididymis was not separately palpable. An abdominal USG (My-LabTM 60 (Esaote, Genoa, Italy) was normal. USG of the scrotum revealed enlarged, ill-defined, hypoechoic right testis and epididymis with multiple linear and punctate bright, highly reflective hyperechoic foci suggestive of gas shadows [Figure 1]. The wall of the scrotal sac also showed linear highly reflective hyperechoic gas shadows on the right side. Left testis was normal and colour Doppler of right testis showed absence of normal testicular parenchymal vascularity [Figure 2]. A plain radiograph of the scrotum showed pockets of radiolucent areas within the soft tissues of the scrotum [Figure 3]. CT (Siemens SOMATOM Definition, Germany) and MRI (GE Signa HDx 1.5T MRI, USA) of the abdomen/pelvis and scrotum were obtained to confirm the diagnosis, see the extent of involvement and exclude Fournier's gangrene. CT demonstrated a multi-loculated collection of gas with thin septa in the right testis and epididymis with air fluid levels in the scrotal wall [Figure 4]. MRI of the pelvis and scrotum revealed intraparenchymal air that was hypointense on all sequences in the testis, epididymis and scrotal wall along with the hyperintense septa in right testis, peritesticular collection and thickened scrotal wall [Figure 5]. A diagnosis of right emphysematous epididymo-orchitis with cellulitis of scrotal wall was made and the patient was given intravenous antibiotics and taken up for surgery. Right orchidectomy was performed with surgical debridement and the patient made an uneventful postoperative recovery.

Bottom Line: Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue.Patient presents with fever, acute pain, swelling and tenderness in the scrotum.Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Central Hospital, Lalaguda, South Central Railway, Secunderabad, Andhra Pradesh, India.

ABSTRACT
Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue. Patient presents with fever, acute pain, swelling and tenderness in the scrotum. Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion. We report a case of emphysematous epididymo-orchitis with imaging findings on plain radiography, ultrasound, CT and MRI and a brief review of the literature.

No MeSH data available.


Related in: MedlinePlus