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Epididymoorchitis
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Acute scrotum, epididymitis, orchitis, mumps
            • Definitions

              • Infectious inflammation of epididymis, testicle, or both
              • Orchitis alone much less common than epididymoorchitis

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Fluoroscopic Findings

                  • Nuclear Medicine Findings

                    • MR Findings

                      • Radiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        Selected References

                                        1. Cordeiro E et al: Mumps outbreak among highly vaccinated teenagers and children in the central region of Portugal, 2012-2013. Acta Med Port. 28(4):435-41, 2015
                                        2. Park SJ et al: Distribution of epididymal involvement in mumps epididymo-orchitis. J Ultrasound Med. 34(6):1083-9, 2015
                                        3. Gkentzis A et al: The aetiology and current management of prepubertal epididymitis. Ann R Coll Surg Engl. 96(3):181-3, 2014
                                        4. Redshaw JD et al: Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol. 192(4):1203-7, 2014
                                        5. Remer EM et al: ACR Appropriateness Criteria ® acute onset of scrotal pain--without trauma, without antecedent mass. Ultrasound Q. 28(1):47-51, 2012
                                        6. Rizvi SA et al: Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Urol J. 8(1):60-5, 2011
                                        7. Jefferies M et al: Fournier's gangrene in a five year old boy - beware of the child post varicella infection. Ann R Coll Surg Engl. 92(5):W62-3, 2010
                                        8. Muraoka I et al: Acute scrotum caused by vasitis with abscess formation in children with lower urological anomalies. Urology. 76(1):49-52, 2010
                                        9. Baldisserotto M: Scrotal emergencies. Pediatr Radiol. 39(5):516-21, 2009
                                        10. Fukuda S et al: Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schönlein purpura. J Pediatr Urol. 5(1):68-71, 2009
                                        11. Lee JC et al: Imaging of the epididymis. Ultrasound Q. 24(1):3-16, 2008
                                        12. Karmazyn B et al: Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg. 41(3):500-4, 2006
                                        13. Baldisserotto M et al: Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 184(4):1287-92, 2005
                                        14. Dykes TM et al: Coccidioidomycosis of the epididymis and testis. AJR Am J Roentgenol. 184(2):552-3, 2005
                                        15. Singh SK et al: Urethrovasocutaneous fistula in a case of anterior urethral stricture. Urol Int. 74(1):86-8, 2005
                                        16. Akin EA et al: Ultrasound of the scrotum. Ultrasound Q. 20(4):181-200, 2004
                                        17. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42(2):349-63, 2004
                                        18. Huang LH et al: Diagnosis of Henoch-Schonlein purpura by sonography and radionuclear scanning in a child presenting with bilateral acute scrotum. J Microbiol Immunol Infect. 37(3):192-5, 2004
                                        19. Ishigami K et al: Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia. J Clin Ultrasound. 32(7):365-9, 2004
                                        20. Jalal H et al: Mumps epididymo-orchitis with prolonged detection of virus in semen and the development of anti-sperm antibodies. J Med Virol. 73(1):147-50, 2004
                                        21. Lindehall B et al: Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction. J Urol. 172(4 Pt 2):1686-8, 2004
                                        22. Somekh E et al: Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol. 171(1):391-4; discussion 394, 2004
                                        23. Willetts IE et al: Laparoscopic excision of a prostatic utricle in a child. Pediatr Surg Int. 19(7):557-8, 2003
                                        24. Pimpalwar A et al: Cysts of the ejaculatory system--a treatable cause of recurrent epididymo-orchitis in children. Eur J Pediatr Surg. 12(4):281-5, 2002
                                        25. Tarantino L et al: Echo color Doppler findings in postpubertal mumps epididymo-orchitis. J Ultrasound Med. 20(11):1189-95, 2001
                                        26. Bukowski TP et al: Epididymitis in older boys: dysfunctional voiding as an etiology. J Urol. 154(2 Pt 2):762-5, 1995
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Acute scrotum, epididymitis, orchitis, mumps
                                                  • Definitions

                                                    • Infectious inflammation of epididymis, testicle, or both
                                                    • Orchitis alone much less common than epididymoorchitis

                                                  IMAGING

                                                  • General Features

                                                    • Ultrasonographic Findings

                                                      • Fluoroscopic Findings

                                                        • Nuclear Medicine Findings

                                                          • MR Findings

                                                            • Radiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              Selected References

                                                                              1. Cordeiro E et al: Mumps outbreak among highly vaccinated teenagers and children in the central region of Portugal, 2012-2013. Acta Med Port. 28(4):435-41, 2015
                                                                              2. Park SJ et al: Distribution of epididymal involvement in mumps epididymo-orchitis. J Ultrasound Med. 34(6):1083-9, 2015
                                                                              3. Gkentzis A et al: The aetiology and current management of prepubertal epididymitis. Ann R Coll Surg Engl. 96(3):181-3, 2014
                                                                              4. Redshaw JD et al: Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol. 192(4):1203-7, 2014
                                                                              5. Remer EM et al: ACR Appropriateness Criteria ® acute onset of scrotal pain--without trauma, without antecedent mass. Ultrasound Q. 28(1):47-51, 2012
                                                                              6. Rizvi SA et al: Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Urol J. 8(1):60-5, 2011
                                                                              7. Jefferies M et al: Fournier's gangrene in a five year old boy - beware of the child post varicella infection. Ann R Coll Surg Engl. 92(5):W62-3, 2010
                                                                              8. Muraoka I et al: Acute scrotum caused by vasitis with abscess formation in children with lower urological anomalies. Urology. 76(1):49-52, 2010
                                                                              9. Baldisserotto M: Scrotal emergencies. Pediatr Radiol. 39(5):516-21, 2009
                                                                              10. Fukuda S et al: Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schönlein purpura. J Pediatr Urol. 5(1):68-71, 2009
                                                                              11. Lee JC et al: Imaging of the epididymis. Ultrasound Q. 24(1):3-16, 2008
                                                                              12. Karmazyn B et al: Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg. 41(3):500-4, 2006
                                                                              13. Baldisserotto M et al: Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 184(4):1287-92, 2005
                                                                              14. Dykes TM et al: Coccidioidomycosis of the epididymis and testis. AJR Am J Roentgenol. 184(2):552-3, 2005
                                                                              15. Singh SK et al: Urethrovasocutaneous fistula in a case of anterior urethral stricture. Urol Int. 74(1):86-8, 2005
                                                                              16. Akin EA et al: Ultrasound of the scrotum. Ultrasound Q. 20(4):181-200, 2004
                                                                              17. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42(2):349-63, 2004
                                                                              18. Huang LH et al: Diagnosis of Henoch-Schonlein purpura by sonography and radionuclear scanning in a child presenting with bilateral acute scrotum. J Microbiol Immunol Infect. 37(3):192-5, 2004
                                                                              19. Ishigami K et al: Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia. J Clin Ultrasound. 32(7):365-9, 2004
                                                                              20. Jalal H et al: Mumps epididymo-orchitis with prolonged detection of virus in semen and the development of anti-sperm antibodies. J Med Virol. 73(1):147-50, 2004
                                                                              21. Lindehall B et al: Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction. J Urol. 172(4 Pt 2):1686-8, 2004
                                                                              22. Somekh E et al: Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol. 171(1):391-4; discussion 394, 2004
                                                                              23. Willetts IE et al: Laparoscopic excision of a prostatic utricle in a child. Pediatr Surg Int. 19(7):557-8, 2003
                                                                              24. Pimpalwar A et al: Cysts of the ejaculatory system--a treatable cause of recurrent epididymo-orchitis in children. Eur J Pediatr Surg. 12(4):281-5, 2002
                                                                              25. Tarantino L et al: Echo color Doppler findings in postpubertal mumps epididymo-orchitis. J Ultrasound Med. 20(11):1189-95, 2001
                                                                              26. Bukowski TP et al: Epididymitis in older boys: dysfunctional voiding as an etiology. J Urol. 154(2 Pt 2):762-5, 1995