Role of Funiculitis in Sonographic Diagnosis of Acute Epididymitis

Ultrasonography is the gold standard for diagnosing acute epididymitis. However, it is not well understood if the simultaneous inflammation of the spermatic cord (funiculitis) is a helpful imaging finding in diagnosing acute epididymitis. This study aimed to investigate the frequency of funiculitis in cases of epididymitis and determine its sensitivity and specificity. This retrospective study included 50 consecutive patients with acute epididymitis. Funiculitis was defined as increased echogenicity of the spermatic cord fat with mass-like cord thickening. All scrotal ultrasound examinations were reviewed for the size of the spermatic cord and surrounding fat, indistinct margins between the spermatic cord and epididymis, similar findings on the contralateral side, and scrotal wall thickening. Spermatic cord inflammation was present in 96% (48/50) of patients with acute epididymitis, significantly higher than in the asymptomatic side (18%, n = 9/50, P < 0.0001). The presence of funiculitis had a sensitivity of 95.9% (confidence interval [CI] 86-99.5%), a specificity of 81.6% (CI 68-91.2%), a positive predictive value of 83.9% (CI 71.7-93%), and a negative predictive value of 95.2% (CI 84-99%) for diagnosing acute epididymitis. The sonographic presence of funiculitis in the setting of acute scrotal pain is a sensitive marker for concomitant acute epididymitis.