Testicular infarction secondary to acute inflammatory disease: demonstration by B-scan ultrasound

Acute epididymitis can lead to obstruction of the adjacent testicular blood supply, resulting in focal or diffuse infarction of the testis or epididymis in the absence of torsion. Four cases are presented to demonstrate the spectrum of B-scan ultrasound findings, ranging from focal necrosis of the epididymis and ischemic infarction of the testis to diffuse testicular infarction. Epididymal enlargement and skin thickening are consistently seen on ultrasound as well as swelling and decreased echogenicity of the testicle. The authors suggest a protocol for acute scrotal symptoms, incorporating clinical findings and (where appropriate) radionuclide scans.