UMEM Educational Pearls

Title: What's the Diagnosis?

Posted: 2/13/2017 by Tu Carol Nguyen, DO
Click here to contact Tu Carol Nguyen, DO

Question

56 year-old male with history of hypertension presents with complaints of right scrotal swelling and pain. Denies any urinary symptoms, abdominal pain, nausea/vomiting or change in bowel habits or prior episodes. Temp was 99.0.

A scrotal ultrasound was done and an image of the right testis was seen (below). What's the diagnosis?

Answer

Answer: Right Epididymitis (and Hydrocele)

Take Home Points:

Epididymitis is heterogeneous on grayscale US
- 100% sensitivity of acute inflammation if hypervascular on Color Doppler
Treatment:
- Age < 35 years and sexually active - more commonly caused by C. trachomatis or N. gonorrhoeae
  - Ceftriaxone 250mg IM once + Doxycycline 100mg BID x 10 days
- Age > 35 years - more comonly caused by obstructive urinary disease (enteric organisms)
  - Levaquin 500mg daily x 10 days OR Ofloxacin 300mg BID x 10 days

References

Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography. 2016;35(3):180-97.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3): 1-137.