Case report on secondary testicular necrosis due to fulminant epididymitis: ultrasonographic evaluation and diagnosis

Wout Devlies,Mattias Seghers,Kurt Dilen

doi:10.1186/s12894-020-00655-w

Abstract

BackgroundScrotal pain is a common complaint in the clinical practice, with many underlying causes. Infectious causes, like epididymitis, are frequently encountered in the work-up of scrotal pain. The presentation of epididymitis is mostly mild, yet major complications can occur.Case presentationWe present a 35-year-old male presenting with scrotal pain and swelling of the testicle. Epididymitis with testicular necrosis was diagnosed using repeated doppler ultrasonography measurements. An orchiectomy was performed which showed a hemorrhagic process with affected spermatic cord. Funiculitis together with epididymal swelling can impede testicular blood flow, with testicular necrosis possibly resulting in orchiectomy. This is the first case that proved funiculitis to co-exist in loss of colour doppler on pathological evaluation.ConclusionsIn order to reduce major complications, medical therapy should be promptly initiated when there is a suspicion of epididymitis.

Highlights

Scrotal pain is a common complaint in the clinical practice, with many underlying causes
In order to reduce major complications, medical therapy should be promptly initiated when there is a suspicion of epididymitis
Acute scrotal pain is frequently encountered at the emergency department

Summary

Background

Testicular torsion and major epididymo-orchitis can be difficult to distinguish This distinction is made on blood results with infectious episodes resulting in higher Creactive protein levels. On ultrasonography epididymo-orchitis necrosis can be recognized by a juxta-epididymal string-of-bead sign, contrasting the whirlpool/knot sign, seen in testicular torsion [4]. Case presentation A 35-year old male, with no relevant past medical history, presented to the emergency room with local swelling, fever of 39.4 °C (103 °F) and pain in the right hemiscrotum. It started mildly a week earlier and he was started on ciprofloxacin 500 mg since 4 days.

Discussion

Conclusion