page_title: Scrotal ultrasound
section_title: Epididymitis and epididymo-orchitis
hierarchical_section_title: Scrotal ultrasound / Inflammation / Epididymitis and epididymo-orchitis
caption_attribution_description: English: Scrotal ultrasonography of epididymo-orchitis
context_page_description: Scrotal ultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.
context_section_description: Epididymitis and epididymo-orchitis are common causes of acute scrotal pain in adolescent
  boys and adults. At physical examination, they usually are palpable as tender and enlarged
  structures. Clinically, this disease can be differentiated from torsion of the spermatic cord by
  elevation of the testes above the pubic symphysis. If scrotal pain decreases, it is more likely
  to be due to epidiymitis rather than torsion (Prehn's sign). Most cases of epididymitis are
  secondary to sexually transmitted disease or retrograde bacteria infection from the urinary
  bladder. The infection usually begins in the epididymal tail and spreads to the epididymal
  body and head. Approximately 20% to 40% of cases are associated with orchitis due to
  direct spread of infection into the testis.
  At ultrasound, the findings of acute epididymitis include an enlarged hypoechoic or
  hyperechoic (presumably secondary to hemorrhage) epididymis [Fig. 20a]. Other signs of
  inflammation such as increased vascularity, reactive hydrocele, pyocele and scrotal wall
  thickening may also be present. Testicular involvement is confirmed by the presence of
  testicular enlargement and an inhomogeneous echotexture. Hypervascularity on color
  Doppler images [Fig. 20b] is a well-established diagnostic criterion and may be the only
  imaging finding of epididymo-orchitis in some men.
caption: Epididymo-orchitis in a 77-year-old man. (a) Transverse sonography shows enlargement of the epididymis with hypoechogenicity noted over the testis and epididymis associated with scrotal wall thickening. (b) Color Doppler sonography showed hyperemic change of the testis and epididymis, presenting as an “inferno” vascular flow pattern.[citation needed]
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