Vasitis: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Vasitis or inflammation of the vas deferens is a rarely described condition categorized by Chan & Schlegel1 as either generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Clinically, infectious vasitis presents with nonspecific symptoms of localized pain and swelling that can be confused with other, more common conditions such as epididymitis, orchitis, testicular torsion, and inguinal hernia. Ultrasound with duplex Doppler scanning can be used to exclude epididymitis, orchitis, and testicular torsion. On the other hand, while inguinal hernia is difficult to differentiate from vasitis using ultrasound, computed tomography (CT) is diagnostic. We describe 2 cases of vasitis with clinical and ultrasound findings that initially were interpreted as inguinal hernias. In both patients, CT was diagnostic for vasitis showing an edematous spermatic cord and no hernia. Urine cultures in both patients were negative, but the symptoms resolved with antibiotic treatment.