Sonographic findings in tuberculous epididymitis and epididymo-orchitis

This paper presents the sonographic findings in scrotums of patients affected with tuberculous epididymitis or epididymo-orchitis.

Eighteen patients with a total of 22 abnormal hemiscrotums (4 patients had bilateral lesions) underwent scrotal sonography. Pathologic confirmation was obtained via epididymectomy in 10 cases, epididymo-orchiectomy in 7 cases, and scrotal exploration and biopsy in 3 cases. The histopathologic diagnosis was tuberculous epididymitis in 12 cases and epididymo-orchitis in 8 cases.

Lesions involved the head of the epididymis in 8 cases, the tail in 5 cases, and the entire epididymis in 9 cases. The enlarged epididymis was hypoechoic in 13 cases, hyperechoic in 2 cases, and of mixed echogenicity in 7 cases. The echotexture was heterogeneous in 17 cases and homogeneous in 5 cases. Testicular involvement in 7 cases appeared as a diffusely enlarged hypoechoic testis in 2 cases, an ill-defined hypoechoic lesion in 1 case, a well-demarcated hypoechoic lesion in 2 cases, and multiple small hypoechoic nodules in an enlarged testis in 2 cases. Hydrocele, sinus tract, and extratesticular calcifications were seen in 12, 4, and 2 cases, respectively.

The heterogeneous and hypoechoic swelling of the epididymis or the concomitant hypoechoic lesion of the testis with associated sinus tract or extratesticular calcifications may be helpful in the diagnosis of tuberculous epididymitis or epididymo-orchitis, especially in patients with known genitourinary tuberculosis.