page_title: Scrotal ultrasound
section_title: Tuberculous epididymo-orchitis
hierarchical_section_title: Scrotal ultrasound / Inflammation / Tuberculous epididymo-orchitis
caption_attribution_description: English: Scrotal ultrasonography of a tuberculous 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: Although the genitourinary tract is the most common site of extra-pulmonary involvement
  by tuberculosis, tuberculous infection of the scrotum is rare and occurs in approximately 7%
  of patients with tuberculosis. At the
  initial stage of infection, the epididymis alone is involved. However, if appropriate
  antituberculous treatment is not administered promptly, the infection will spreads to the
  ipsilateral testis. The occurrence of isolated testicular tuberculosis is rare. Clinically patients with tuberculous epididymo-orchitis may present with painful or painless enlargement of the scrotum, hence they cannot be distinguished from lesions such as testicular tumor, testicular infarction and may mimic testicular torsion.
  At ultrasound, tuberculous epididymitis is characterized by an enlarged epididymis with
  variable echogenicity. The presence of calcification, caseation necrosis, granulomas and
  fibrosis can result in heterogeneous echogenicity [Fig. 21a]. The ultrasound findings of
  tuberculous orchitis are as follow: (a) diffusely enlarged heterogeneously hypoechoic testis
  (b) diffusely enlarged homogeneously hypoechoic testis (c) nodular enlarged
  heterogeneously hypoechoic testis and (d) presence of multiple small hypoechoic nodules in
  an enlarged testis [Fig. 21b].
  Although both bacterial and tuberculous infections may involve both the epididymis and
  the testes, an enlarged epididymis with heterogeneously hypoechoic pattern favors a
  diagnosis of tuberculosis (Muttarak and Peh, 2006, as cited in Kim et al., 1993 and Chung et al., 1997). With color Doppler ultrasound, a diffuse increased blood flow pattern is seen in
  bacterial epididymitis, whereas focal linear or spotty blood flow signals are seen in the
  peripheral zone of the affected epididymis in patients with tuberculosis.
caption: Fig. 21. Tuberculous epididymo-orchitis. (a) Transverse sonography of a surgically proved tuberculous epididymitis shows an enlarged epididymis containing calcification and necrosis. (b) Composite image: Transverse sonography of the same patient shows multiple hypoechoic nodules in the left testis associated with surrounding reactive hydrocele.[citation needed]
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