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
70year old male presents with pain in the right testis. US in transverse projection shows heterogeneity of the right testis and enlargement of the epididymis consistent with a diagnosis of epididymo orchitis
Ashley Davidoff MD 133197
US in the sagittal plane through the right testis shows enlargement and heterogeneity of the head of the right epididymis as well as heterogeneity of the right testis consistent with the diagnosis of epididymitis and orchitis.
Ashley Davidoff MD 133201 Doppler US in the longitudinal plane through the right testis shows hypervascularity both of the of the right testis and epididymis, consistent with the diagnosis of acute orchitis and epididymitis .
Ashley Davidoff MD 133194 b02 US in the sagittal plane through the right testis and epididymis shows mild thickening of the overlying skin and an enlarged epididymis associated with a small hydrocele consistent with the diagnosis of acute epididymitis
Ashley Davidoff MD 133105 US in the transverse plane through the tail of the right epididymis (above) shows enlargement of the epididymis and significant hyperemia (below) consistent with the diagnosis of acute epididymitis
Ashley Davidoff MD 133121c
? TB
US in the sagittal plane through the right testis shows a mass in the tail of the testes with mass effect of the epididymis on the testis. Associated findings include thickening of the scrotal skin and a hydrocele Ashley Davidoff MD 133286Doppler US in the sagittal plane through the right epididymis shows mild hyperemia of the epididymis. Ashley Davidoff MD 133290
7 years Later
7 years later he again had pain and there was persistent recurrent epididymitis and simple hydrocele which progressed over the next few months to a complex hydrocele
US in the transverse plane through the tail of the right epididymis again shows mass like heterogeneous appearance with mass effect on the testis, necrotic fluid collection, skin thickening and simple hydrocele
Ashley Davidoff MD 133313
7 years later he again presented with pain, and US in the sagittal plane through the right testis and epididymis shows significant persistent enlargement of the epididymis with heterogeneity with cystic spaces, skin thickening and a simple hydrocele consistent with the diagnosis of acute on chronic epididymitis of the right epididymis
Ashley Davidoff MD 133312 Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis, moderate hyperemia of the epididymis, associated with skin thickening and hydrocele consistent with acute on chronic ongoing epididymitis.
Ashley Davidoff MD 133320
EPIDIDYMO-ORCHITIS
Heterogeneous Testis Reflecting Orchitis
50 M with US showing heterogeneous testis likely reflecting orchitis
Ashley Davidoff50 M with US showing heterogeneous testis likely reflecting orchitis
Ashley Davidoff
Classical Epididymo Orchitis
70 year old male presents with pain in the right testes
US in the transverse plane through both testes shows thickening of the skin overlying the right testis, enlargement, heterogeneity and overall decrease in echogenicity of the right testis all consistent with the diagnosis of orchitis.
Ashley Davidoff MD
133207Doppler US in the transverse plane through both testes shows hypervascularity of the right testis consistent with the diagnosis of orchitis.
Ashley Davidoff MD
133206US in transverse projection shows heterogeneity of the right testis and enlargement of the epididymis consistent with a diagnosis of epididymo orchitis
Ashley Davidoff MD 133197Doppler US of the right testis shows significant hyperemia of the testes as well as hyperemia and swelling of the epididymis medially
Ashley Davidoff MD 13319270year old male presents with pain in the right testis. US in transverse projection shows heterogeneity of the right testis and enlargement of the epididymis consistent with a diagnosis of epididymo orchitis
Ashley Davidoff MD 133197US in the sagittal plane through the right testis shows enlargement and heterogeneity of the head of the right epididymis as well as heterogeneity of the right testis consistent with the diagnosis of epididymitis and orchitis.
Ashley Davidoff MD 133201US in the transverse plane through the right testis shows enlargement, heterogeneity of the right epididymis consistent with the diagnosis of epididymitis. Note the presence of a prominent hypoechoic rete testis at the hilum of the testis
Ashley Davidoff MD 133199Doppler US in the longitudinal plane through the right testis shows hypervascularity both of the of the right testis and epididymis, consistent with the diagnosis of acute orchitis and epididymitis .
Ashley Davidoff MD 133194 b02
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 133157b01US 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 133157b06US 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 133157b14Doppler 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 133160cUS 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 133173Doppler 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 133166Doppler 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
The Snowstorm Hydrocele and Swollen Spermatic Cord
74 Year Old Male with Pain and Swelling of the Right Testis and Hydrocele
US in the transverse plane through both testes shows thickened overlying skin, more prominent over the right testis, no significant difference in the echogenicity of the testes but prominent right epididymis and small hydrocele
Ashley Davidoff MD 133097Doppler US in the sagittal plane through testes shows hyperemia of the right testis and epididymis consistent with orchitis and epididymitis
Ashley Davidoff MD 133157US in the sagittal plane through the right testis and epididymis shows mild thickening of the overlying skin and an enlarged epididymis associated with a small hydrocele consistent with the diagnosis of acute epididymitis
Ashley Davidoff MD 133105US in the transverse plane through the tail of the right epididymis (above) shows enlargement of the epididymis and significant hyperemia (below) consistent with the diagnosis of acute epididymitis
Ashley Davidoff MD 133121cDoppler US in the sagittal plane through the tail of the right epididymis shows enlargement of the epididymis and significant hyperemia consistent with the diagnosis of acute epididymitis
Ashley Davidoff MD 133124US in the sagittal plane through the right testis shows a moderate hydrocele with snowstorm appearance caused either by cholesterol crystalline particles or high protein content, likely of no clinical significance
Ashley Davidoff MD 133103
Mass like Epididymitis with Complex Hydrocele ? TB
73-year male with granulomatous lung disease presents with acute right testicular pain. US showed mass like enlargement of the epididymis attached to and compressing the right testis with a small hydrocele
US in the sagittal plane through the right testis shows a mass in the tail of the testes with mass effect of the epididymis on the testis. Associated findings include thickening of the scrotal skin and a hydrocele
Ashley Davidoff MD 133286US in the sagittal plane through the right testis shows calcifications in the mass in the tail of the epididymis suggesting chronicity. Again noted is the mass effect of the epididymis on the testis with associated findings of thickening of the scrotal skin and a hydrocele. These findings suggest acute on chronic epididymitis, and granulomatous disease such as TB and dystrophic calcifications are also a possibility
Ashley Davidoff MD 133293
Doppler US in the sagittal plane through the right epididymis shows mild hyperemia of the epididymis suggesting mild acute on chronic epididymitis.
Ashley Davidoff MD 133290Doppler US in the transverse plane through the right testis and epididymis shows normal vascularity to the right testis and mild hyperemia of the epididymis.
Ashley Davidoff MD 133296
2 weeks later US showed persistent but improved enlargement of the right epididymis.
2 weeks later US in the sagittal plane showed persistent but improved enlargement of the left epididymis and persistent skin thickening. Microcalcifications are noted in the testis
Ashley Davidoff MD 133302US in the sagittal plane of the left testis shows persistent mass effect of the epididymis on the testis. There is persistent skin thickening and hydrocele.
Ashley Davidoff MD 133305Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis and mild hyperemia of the epididymis, and skin thickening consistent with mild ongoing epididymitis.
Ashley Davidoff MD 133309
7 years Later
7 years later he again had pain and there was persistent recurrent epididymitis and simple hydrocele which progressed over the next few months to a complex hydrocele
7 years later he again presented with pain, and US in the sagittal plane through the right testis and epididymis shows significant persistent enlargement of the epididymis with heterogeneity with cystic spaces, skin thickening and a simple hydrocele consistent with the diagnosis of acute on chronic epididymitis of the right epididymis
Ashley Davidoff MD 133312US in the transverse plane through the tail of the right epididymis again shows mass like heterogeneous appearance with mass effect on the testis, necrotic fluid collection, skin thickening and simple hydrocele
Ashley Davidoff MD 133313Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis, moderate hyperemia of the epididymis, associated with skin thickening and hydrocele consistent with acute on chronic ongoing epididymitis.
Ashley Davidoff MD 133320
2 months later
2 months later US in the transverse plane through the scrotal sac is dominated by a large complex loculated hydrocele compressing the enlarged right epididymis and testis.
Ashley Davidoff MD 133330Doppler US in the sagittal plane through the right testis and epididymis shows normal vascularity to the testis and epididymis, both significantly compressed by a complex hydrocele.
Ashley Davidoff MD 133330
A Further 2 Months Later
2 months later US in the transverse plane through the scrotal sac is dominated by a large complex loculated hydrocele characterized by progressive thickening of the septations compressing the right testis.
Ashley Davidoff MD 133332
These findings and the chronic history are most consistent with Tuberculous epididymitis
Epididymal Abscess
88 year old male presents with left scrotal pain and swelling
US in the sagittal plane through the right hemiscrotum shows a loculated collection in the left epididymis with compression of the left testis. Associated findings include overlying skin thickening. These findings are consistent with an epididymal abscess
Ashley Davidoff MD 133175
Calcifications of the Epididymis
? TB
US in the sagittal plane through the right testis shows calcifications in the mass in the tail of the epididymis suggesting chronicity. Again noted is the mass effect of the epididymis on the testis with associated findings of thickening of the scrotal skin and a hydrocele. These findings suggest acute on chronic epididymitis, and granulomatous disease such as TB and dystrophic calcifications are also a possibility
Ashley Davidoff MD 133293
Subacute Abscess
US in the sagittal plane through the left testis shows a shadowing microcalcifications in the left epididymal collection suggesting chronicity.
US in the sagittal plane through the right testis shows enlargement and heterogeneity of the head of the right epididymis as well as heterogeneity of the right testis consistent with the diagnosis of epididymitis and orchitis.
Doppler US in the longitudinal plane through the right testis shows hypervascularity both of the of the right testis and epididymis, consistent with the diagnosis of acute orchitis and epididymitis .
US in the sagittal plane through the right testis and epididymis shows mild thickening of the overlying skin and an enlarged epididymis associated with a small hydrocele consistent with the diagnosis of acute epididymitis
US in the transverse plane through the tail of the right epididymis (above) shows enlargement of the epididymis and significant hyperemia (below) consistent with the diagnosis of acute epididymitis
US in the transverse plane through the tail of the right epididymis again shows mass like heterogeneous appearance with mass effect on the testis, necrotic fluid collection, skin thickening and simple hydrocele
US in the sagittal plane through the left testis shows a shadowing microcalcifications in the left epididymal collection suggesting chronicity.