Reversal of diastolic flow in epididymo-orchitis: a red flag for impending testicular infarction

Epididymo-orchitis usually responds to antibiotics, yet a small subset of patients progress to testicular infarction, a rare but serious complication. We describe a 73-year-old man with epididymo-orchitis and a pyocele whose initial ultrasound demonstrated reversal of diastolic intratesticular flow, in keeping with impending infarction. Despite transient improvement with antibiotics, he re-presented on day 8 with recurrent pain and near-complete infarction on repeat ultrasound, with persistent reversed diastolic flow in regions of preserved vascularity. This case highlights reversal of diastolic flow as a radiological red flag in epididymo-orchitis and suggests practical recommendations for Doppler assessment, early repeat imaging, and urgent urological review.