Testicular infarction secondary to epididymo-orchitis

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 gonorrhoae, 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 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. Grayscale US findings of epididymo-orchits are enlarged hypoechoic epididymis and testis. These findings are non-specific and indistinguishable from testicular torsion but color 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 edema of the testis are contributory factors. Other complications of epididymo-orchitis include testicular abscess [3].