003Te 65M Recurrent Epididymitis

Recurrent Epididymitis
65 year old Male with Recurrent Epididymitis

9 months prior presented with mild left sided testicular pain

US in the transverse plane through both testes shows heterogeneity and decrease echogenicity of the left testis as well as enlargement of the left epididymis consistent with the diagnosis of epididymitis and orchitis.
Ashley Davidoff MD 133157b01
US in the sagittal plane of the left testis and epididymis shows enlargement of left epididymis with cystic changes and dilatation of tubules or small focal abscess in the head of the epididymis reflecting chronic or mild acute on chronic epididymitis
Ashley Davidoff MD 133157b05

US in the sagittal plane of the body and tail of the epididymis shows diffuse enlargement of left epididymis reflecting chronic or mild acute on chronic epididymitis
Ashley Davidoff MD 133157b06
US in the sagittal plane through the right (normal) and left (enlarged) left epididymis testis consistent with the diagnosis of epididymitis of the left epididymis
Ashley Davidoff MD 133157b14
Doppler US in the transverse plane through the left testis shows no significant hypervascularity of the testis but mild increase in vascularity of the head of the epididymis. This finding in association with the noted mild hypoechogenicity in the presence of mild pain would suggest mild acute on chronic epididymitis and orchitis.
Ashley Davidoff MD 133157b12
9 months later  65 year old male presents with recurrent pain in the left testis
US in the transverse plane through both testes shows thickening of the skin overlying the left testis,  no significant difference in the echogenicity of the testes, but a persistent prominence of the head of the left epididymis associated with a small hydrocele
Ashley Davidoff MD 133160c
US in the transverse plane through the left epididymis shows significant enlargement of the epididymis with cystic spaces in the head, associated with a small hydrocele consistent with the diagnosis of acute on chronic epididymitis of the left epididymis
Ashley DAvidoff MD 133173
Doppler US in the sagittal plane through the left epididymis shows hyperemia of the epididymis consistent with the diagnosis of acute epididymitis of the left epididymis
Ashley Davidoff MD 133166
Doppler US in the transverse plane through the left epididymis shows hyperemia of the epididymis and unchanged appearance of the cystic lesion previously identified in the neck of the of the epididymis
Ashley Davidoff MD 133168