Presentation
Epididymitis which did not respond to IV antibiotics
Patient Data
Patient underwent color Doppler ultrasonography of the testes that showed increased vascularity and increased resistive index of the right testis, with gross enlargement of the right testis.
The ultrasound findings were suggestive of epididymo-orchitis.
Follow up ultrasound exam shows no flow in the right testis with color Doppler imaging.
- pathology exam showed extensive necrosis with acute on chronic inflammation and some hemorrhage and fibrosis involving epididymis and spermatic cord and the right testis
- patient underwent scrotal exploration, which revealed a necrotic right testis and epididymitis
Case Discussion
Testicular ischemia secondary to non-responding epididymitis to antibiotics is rare.
Color flow Doppler ultrasound is required to assess the involved testis in patients with epididymitis who respond initially to antibiotics and later develop pain, tenderness and fevers during the course of treatment.
In this case, no flow was detected six days after initial antibiotic therapy and patient had ongoing pain, tenderness and febrile episodes while on broad-spectrum IV antibiotics.
Surgical exploration and orchiectomy were performed after color flow Doppler ultrasound showed no flow in the affected testis.