Phillip Lung, Presenter: Nothing to Disclose

Ounali Jaffer MBBS, MRCP, Abstract Co-Author: Nothing to Disclose

Aarti Shah MD, Abstract Co-Author: Nothing to Disclose

Maria E Sellars MD, Abstract Co-Author: Nothing to Disclose

Paul Singh Sidhu MD, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG, Erlanger Speaker, Hitachi, Ltd

To determine the role and usefulness of CEUS in ascertaining the nature of focal testicular lesions found in patients with unilateral severe epididymitis.

All intra-testicular lesions identified in the ipsilateral testis in patients with severe epididymitis (not responding to medical care) were subject to B-mode and color Doppler ultrasound (US), with CEUS performed by a single operator using multi-frequency linear array transducers on either a Sequoia or S2000 (Siemens, Mountain View, CA) and SonoVue™ 4.8 mLs (Bracco SpA, Milan, Italy) administrated as contrast. Images were recorded for review by consensus by two blinded experienced observers. The age, site, nature of B-mode appearances, color pattern, post-CEUS appearances, and an interpretation of the findings on CEUS were noted. Associated findings were recorded. Histology, clinical findings or follow-up US provided the final diagnosis.

Over 3 years 14 patients were examined, mean age 56 years (range 18-81 years). There were 11 left and 3 right sided lesions identified with confirmed US features of epididymitis. The mean size of the lesion was 34 mm (range 13-43mm), oval (n=12), wedge (n=1) in shape or involving the entire testis (n=1). The lesions were iso-echoic (n=4), hypo-echoic (n=5) or heterogeneous (n=4) to the normal testis. There was poor color Doppler flow to all but one lesion. Following CEUS, there was clear demarcation of avascular areas demonstrating no flow in 13 lesions, and increase flow in one (focal orchitis). Rim enhancement (n=7), vascular projections (n=4), irregular borders (n=7) were likely to identify an abscess, smooth borders (n=7) identified venous infarction. The consensus observers identified venous infarction (n=8), abscess (n=5) and orchitis (n=1) on the CEUS examinations. Histology confirmed venous infarction (n=2) and abscess formation (n=2), follow-up US confirmed resolution (n=7), 3 patients were lost to follow-up. Associated findings better define with CEUS were tumour (n=2) and epididymal abscess (n=2).

CEUS is a useful adjuvant to a color Doppler US examination of a focal lesion in the testis ipsilateral to epididymitis to clearly identify non-vascularized tissue to allow for appropriate clinical management.

The use of additional imaging with CEUS will allow for a confident diagnosis of venous infarction or abscess formation in the testis ipsilateral to severe epididymitis.

Lung, P, Jaffer, O, Shah, A, Sellars, M, Sidhu, P, Testicular Complications of Severe Epididymitis: Preliminary Findings of the Role of Contrast-enhanced Ultrasound (CEUS) in Interrogating Focal Intratesticular Abnormalities.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007677.html