EURORAD ESR

Case 13227

Epididymal abscess: the value of Contrast enhanced ultrasound

Author(s)
Vasileios Rafailidis, Paul S. Sidhu

Department of Radiology, King’s College Hospital, London, United Kingdom. Email:billraf@hotmail.com
 
Patient
male, 86 year(s)
 
 
  • Figure 1
    Grey-scale ultrasonographic findings
     

    Oblique sonogram of the right hemiscrotum shows hydrocele with multiple echogenic septations.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Infection;

    An enlarged and heterogeneous right epididymis was identified along with a hypoechoic and partially heterogeneous mass situated in its tail. Note the thickened scrotal wall.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Infection;

    The hypoechoic mass containing echogenic septations and foci was seen along with thickening of the right scrotal wall.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Colour Doppler findings
     

    Markedly increased vascularity was identified within the enlarged epididymis.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Infection;

    There was increased vascularity at the periphery of the lesion.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Infection;

    Multiple blood flow signals were found at the periphery of the lesion, along with some greater blood vessels, possibly perfusing internal septations.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    Contrast enhanced ultrasound
     

    Contrast-enhanced ultrasound image with mechanical index of 0.07, at 38 seconds after microbubbles administration demonstrated early increased peripheral vascularity but no blood vessels within the mass.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Contrast agent-intravenous; Special Focus: Infection;

    Contrast-enhanced ultrasound image, at 44 seconds after microbubbles administration clearly confirmed the presence of increased peripheral vascularity but no blood flow within the mass.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Contrast agent-intravenous; Special Focus: Infection;

    The absence of internal vascularity was also confirmed at 58 seconds. Note the normal testicular vascularity and the perfusion of a single vessel near the lesion, in close correlation with Colour Doppler image 2c.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Contrast agent-intravenous; Special Focus: Infection;
     
     
Oblique sonogram of the right hemiscrotum shows hydrocele with multiple echogenic septations.
 
An enlarged and heterogeneous right epididymis was identified along with a hypoechoic and partially heterogeneous mass situated in its tail. Note the thickened scrotal wall.
 
The hypoechoic mass containing echogenic septations and foci was seen along with thickening of the right scrotal wall.
 
Markedly increased vascularity was identified within the enlarged epididymis.
 
There was increased vascularity at the periphery of the lesion.
 
Multiple blood flow signals were found at the periphery of the lesion, along with some greater blood vessels, possibly perfusing internal septations.
 
Contrast-enhanced ultrasound image with mechanical index of 0.07, at 38 seconds after microbubbles administration demonstrated early increased peripheral vascularity but no blood vessels within the mass.
 
Contrast-enhanced ultrasound image, at 44 seconds after microbubbles administration clearly confirmed the presence of increased peripheral vascularity but no blood flow within the mass.
 
The absence of internal vascularity was also confirmed at 58 seconds. Note the normal testicular vascularity and the perfusion of a single vessel near the lesion, in close correlation with Colour Doppler image 2c.
 
 
 
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