ATHENS 4-6 October 2018 European Society of Urogenital Radiology INFECTIOUS SCROTAL CONDITIONS Mustafa SECIL, MD Professor of Radiology, Dokuz Eylul University Faculty of Medicine Department of Radiology IZMIR - TURKEY 2nd ESUR Teaching Course Multimodality Imaging Approach to Scrotal and Penile Pathologies
PLAN Imaging methods Scrotal wall infections Epididymis and testis infections
IMAGING METHODS Sonography Doppler sonography MRI, sometimes CT, rare, specific conditions
SCROTAL WALL INFECTIONS Folliculitis Cellulitis Abscess Fistula Fournier s Gangrene Hidradenitis Suppurativa Secondary infections of scrotal wall
SCROTAL WALL INFLAMMATIONS Radiological Findings Thickening and heterogeneity of the wall Dispersed areas in fluid echogenicity / intensity within the wall Increased vascularity, increased contrast enhancement Loculations Tracts (sinus, fistula)
SCROTAL CELLULITIS
Fournier s Gangrene Polymicrobial necrotizing infection Clostridium perfringens, Klebsiella, Proteus, Streptococcus, Staphylococcus, Peptostreptococcus, Escherichia coli Begins from perineal-scrotal region extending beneath Scarpa s fascia to abdomen, thorax, even neck Diabetic, debilitated, immune-compromized Gas is the hallmark but not an invariable finding
FOURNIER S GANGRENE
FOURNIER S GANGRENE
Hidradenitis suppurativa Chronic inflammation originating from the apocrine glands Genitofemoral region is the second most common area after axilla MR imaging to show the extension and complications, planning of reconstructive surgery
Epididymal and Testicular Infections
Acute Epididymitis, Epididymoorchitis The most common cause of acute scrotum Progressively increasing severe pain end tenderness Pain relieves with elevation of testis (Prehn s sign) Recent urethral discharge or lower urinary tract infection findings
Acute Epididymitis Epididymoorchitis Sexually transmitted diseases N. gonorrhea, C. trachomatis E. coli or P. mirabilis in children and elderly
Acute Epididymitis Epididymoorchitis Descending infection reaching the epididymis via the urinary tract Infection begins at the tail but commonly involves all epididymis Testis secondarily affected in up to 40%
Orchitis Isolated orchitis is rare Acute viral orchitis (mumps far most common)
Acute Epididymitis Epididymoorchitis Radiological Findings Enlarged epididymis ± testis Original echo of epididymis is lost, becomes heterogeneous Focal or diffuse ill-defined hypoechogenic and heterogeneous areas in testis Increased vascularity!!!
Acute Epididymitis Epididymoorchitis Radiological Findings Reactive hydrocele Pyocele Scrotal wall thickening and increased vascularity of the scrotal wall
Acute Epididymitis Epididymoorchitis Tips and Tricks Doppler parameters should be optimized Comparison to the normal side is very important
HEAD TAIL LONGITUDINAL PANORAMIC EPIDIDYMITIS, TAIL INVOLVED ONLY
EPIDIDYMITIS
EPIDIDYMITIS
EPIDIDYMITIS
EPIDIDYMOORCHITIS
EPIDIDYMOORCHITIS, INCREASED VASCULARITY
EPIDIDYMOORCHITIS, INCREASED VASCULARITY
EPIDIDYMAL ABSCESS
LONGITUDINAL PANORAMIC EPIDIDYMOORCHITIS, PYOCELE
EPIDIDYMOORCHITIS, PYOCELE
EPIDIDYMOORCHITIS TESTICULAR ABSCESS
GRANULOMATOUS INFLAMMATIONS Tuberculosis Brucella Sarcoidosis Idiopathic granulomatous xanthogranulomatous
TUBERCULOUS EPIDIDYMITIS
BRUCELLA EPIDIDYMOORCHITIS
XANTHOGRANULOMATOUS EPIDIDYMOORCHITIS
Conclusion Imaging is necessary for diagnosis of scrotal, epididymal and testicular infections Ultrasound + Doppler the major imaging modality MR and CT in selected patients
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