Pediatric Epididimo-Orchitis

  • Etiology:
    — Prepubertal: Structural abnormality, dysfunctional voiding, appendix testis torsion, constipation as straining leads to retrograde flow of urine
    — Adolescent – Urinary tract infection, reflux of urine into vas deferans in patients with neurogenic bladder, sexually transmitted disease (most common cause)
  • Imaging US:
    — Enlarged epididymis and or testicle
    — May have reactive hydrocele
  • Imaging US Color Doppler: Hypervascularity of affected epididymis and or testicle when compared with contralateral side
  • DDX:
  • Complications:
  • Treatment: Treat with course of antibiotics effective against usual urinary pathogens as most cases of epididymitis are result of infection ascending from bladder or from urethra in setting of sexually transmitted disease
  • Clinical:

Radiology Cases of Epididimo-Orchitis

US of epididimo-orchitis
Sagittal (above left) and transverse (below left) color doppler US of the left testicle shows hypervascularity of the left epididymis and testicle when compared to the right testicle (above right).

Radiology Cases of Epididymitis

Color doppler US of epididymitis
Sagittal color doppler US of the right scrotum shows increased flow to the right epididimis compared to the flow in the right testicle, which was shown to be present on spectral doppler US.
US of epididymitis secondary in Henoch-Schonlein Purpura
Transverse color doppler US of the scrotum shows enlargement and hypervascularity of the bilateral crescent shaped epididymides when compared to their respective round testicles, to which they are lateral in position.

Radiology Cases of Orchitis

US of epidimo-orchitis
Sagittal and transverse greyscale US of the left testicle (above) show a heterogenous appearance of the left testicle. Sagittal color doppler US of the left testicle shows increased blood flow to the left testicle and there was also increased blood flow to the left epididymis (not pictured).
US of epididimo-orchitis
Sagittal color and spectral doppler US of the left (above) and right (below) testicles shows normal flow in the left testicle and increased flow in the right testicle.
US of epididimo-orchitis
Sagittal grayscale US (left) shows a morphologically normal appearing right epididymis and testicle while the color doppler US (right) shows increased flow to the right testicle.