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Urogenital Imaging

Orchitis

inflammation of the testis. Acute orchitis may occur as a complication of epididymitis, or as a primary de novo inflammatory process. The latter is believed to be due to the haematogenous dissemination of systemic infection, such as mumps. Patients typically present with severe testicular pain, swelling and tenderness. Mumps orchitis, which interestingly occurs only in postpubertal males, typically develops 3 - 4 days after the onset of parotitis. Orchitis complicates 20 - 35% of cases of mumps in postpubertal males, and is bilateral in 10%. Orchitis is treated symptomatically, with appropriate antibiotics in bacterial cases. Occasionally, surgery is required, if testicular torsion or tumour is suspected. Testicular atrophy may develop after orchitis, and results in a small soft testis, which can be recognized within 1 - 2 months.

On ultrasound, orchitis results in diffuse testicular enlargement and hypoechogenicity (Fig.1). Focal areas of markedly reduced echogenicity indicate abscess formation. Reactive hydrocoeles are common, and may become infected, forming a pyocoele. Severe swelling may compromise the vascular supply, causing secondary focal or diffuse infection of the testis or epididymis. Occasionally, testicular rupture occurs. At MRI, acute orchitis causes heterogeneous or homogeneous reduction in T2 signal intensity. Associated thickening of the overlying scrotal skin may be recognized.

Chronic orchitis may be due to tuberculosis, syphilis, or nonspecific granulomatous inflammatory change. The latter is relatively common, and while the aetiology is unknown, granulomatous orchitis is thought to be the result of an autoimmune response to spermatozoa. Chronic orchitis may present with mild testicular pain or swelling, and can be confused with testicular tumour both clinically and on imaging. Therefore, the correct diagnosis is often made only after orchiectomy.

Inflammatory conditions of the testis may involve the epididymis, and vice versa, with corresponding overlap of both clinical and imaging findings. This is called epididymo-orchitis (Fig.2). Also, see epididymitis

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Fig.1

Longitudinal ultrasound image of the left testis with colour Doppler interrogation. There is markedly increased vascularity, consistent with orchitis.
Orchitis, Fig.1
Orchitis, Fig.2