Scrotal abscess

Clinical History

27-year-old male patient presented with left scrotal pain.

Imaging Findings

Figure 1: Colour Doppler image of the scrotum demonstrates a high resistance flow in the left testis in a patient with known epididymo-orchitis who was being treated for the same. Also seen is septated hydrocele/pyocele (arrows).

Figure 2: Follow-up study demostrates heterogenous appearance of the left testis with loss of its normal contour and surrounding pyocele (a). Complete absence of flow within this abnormal testis consistent with testicular infarction secondary to epididymo-orchitis (b).

Discussion

Epididymitis and epididymo-orchitis are two most common causes of acute scrotal pain in adults. The infection usually originates in the genitourinary tract, particularly the bladder, urethra, and prostate. The most common pathogens are Neisseria gonorrhoea, Chlamydia trachomatis, Escherichia coli, or Proteus mirabilis [1].

The inflammation usually starts in the epididymis and then spreads to the testis. If the patients do not receive appropriate treatment it could result in many complications including pyocele, testicular infarction, testicular abscess, scrotal abscess, and fulminant fasciitis (Fournier’s gangrene).

Patients with epididymo-orchitis usually present with fever, dysuria, and a painful scrotal enlargement. The pain is usually insidious in onset and increases slowly over 1 to several days. The diagnosis of epididymitis usually is based on clinical evaluation and imaging findings. Gray scale US may provide valuable information about tissue morphology. Gray scale US findings of epididymo-orchitis are enlarged hypoechoic epididymis and testis. These findings are non-specific and indistinguishable from testicular torsion but colour Doppler US findings are different. Vascularity is increased in epididymo-orchitis but decreased in testicular torsion [2]. However, advanced epididymo-orchitis may cause testicular infarction as a result of the involvement of the spermatic cord secondary to the spread of inflammatory process from the epididymis, resulting in compression of the testicular artery contributing to decreased blood supply to the testis. In addition, extrinsic compression from pyocele and obstruction to the venous outflow secondary to the marked oedema of the testis are contributory factors. Other complications of epididymo-orchitis include testicular abscess [3].

Differential Diagnosis List

Final Diagnosis

Scrotal abscess

URL:	https://www.eurorad.org/case/12375
DOI:	10.1594/EURORAD/CASE.12375
ISSN:	1563-4086