Epididymal abscess
Epididymal
abscess: the value of Contrast enhanced ultrasound. Oblique sonogram of the right hemiscrotum shows hydrocele with multiple echogenic septations.
Epididymal
abscess: the value of Contrast enhanced ultrasound. The hypoechoic mass containing echogenic septations and foci was seen along with thickening of the right scrotal wall.
Epididymal
abscess: the value of Contrast enhanced ultrasound. There was increased vascularity at the periphery of the lesion.
Epididymal
abscess: the value of Contrast enhanced ultrasound. Multiple blood flow signals were found at the periphery of the lesion, along with some greater blood vessels, possibly perfusing internal septations.
Epididymal
abscess: the value of Contrast enhanced ultrasound. Contrast-enhanced ultrasound image, at 44 seconds after microbubbles administration clearly confirmed the presence of increased peripheral vascularity but no blood flow within the mass.
An epididymal abscess is an uncommon complication of epididymitis.
Pathology
Causative organisms are the same that cause epididymitis:
- older individuals
- Escherichia coli
- Proteus mirabills
- younger individuals
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Other rare etiological agents
- Streptococcus faecalls
- Ureaplasma urealyticum
- viral, spirochete infections
- Mycobacterium tuberculosis (tuberculous epididymitis)
Radiographic features
Ultrasound
Sonographic findings include
- scrotal wall thickening
- hyperemic enlargement of the epididymis
- focal regions of decreased or mixed echogenicity
- nonvascular hypoechoic area surrounded with hypervascular epididymis
Tuberculous epididymal abscesses tend to be larger in size while the degree of blood flow in the peripheral portion of the abscess can be comparatively lower.
Treatment and prognosis
Complications
Further possible complications from an epididymal abscess
- rupture with focal testicular ischemia or infarction
- inflammatory ulceration of the efferent ductules or the ductus epididymis
- may allow sperm to extravasate into the surrounding interstitium, inciting an intense inflammatory response that leads to sperm granuloma formation.
