007Te 48M Pyogenic Orchitis Complicated by Infarction Following Prostate Biopsy
Pyogenic Orchitis Complicated by Infarction Following Prostate Biopsy
48 year old diabetic male presented with an elevated PSA for transrectal biopsy.
10 days after a biopsy, he developed dysuria and hematuria. Urine culture showed E Coli, resistant to many antibiotics but sensitive to nitrofurantoin. He improved after 1 week of antibiotics, but symptoms recurred with right testicular pain and swelling with intermittent fever.
WCC was 18,000 and urine was cloudy with increased sugar
Doppler US showed epididymo-orchitis with no flow to the hypoechoic right testis consistent with an infarcted testis. The patient declined orchiectomy
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 hypo echogenicity in the presence of mild pain would suggest mild acute on chronic epididymitis and orchitis.
CT scan showed an enlarged right testis, induration of the surrounding skin, and around the prostate
as well as thickening and hyperemia of the cord
4 weeks Later
US performed 4 weeks later showed reduction in the size of the right testis and showing a 7mm focal area of necrosis in the parenchyma.