Contrast-Enhanced Ultrasound in the Evaluation of Focal Testicular Complications Secondary to Epididymitis

• Published in: American journal of roentgenology (1976) Vol. 199; no. 3; pp. W345 - W354
• Main Authors: Lung, Phillip F. C., Jaffer, Ounali S., Sellars, Maria E., Sriprasad, Sheshadri, Kooiman, Gordon G., Sidhu, Paul S.
• Format: Journal Article
• Language: English
• Published: United States 01.09.2012
• Subjects: Abscess - diagnostic imaging; Abscess - etiology; Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Epididymitis - complications; Humans; Infarction - diagnostic imaging; Male; Middle Aged; Phospholipids; Sulfur Hexafluoride; Testicular Diseases - diagnostic imaging; Testicular Diseases - etiology; Testicular Neoplasms - diagnostic imaging; Testicular Neoplasms - etiology; Testis - blood supply; Ultrasonography, Doppler, Color; Young Adult
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.11.7997

The purpose of this study is to determine the effectiveness of contrast-enhanced ultrasound in evaluating incidental focal testicular lesions in epididymitis. Intratesticular lesions ipsilateral to epididymitis were subject to B-mode color Doppler ultrasound and contrast-enhanced ultrasound, with their appearances reviewed in consensus. Final interpretation was by histologic analysis or follow-up ultrasound. Over 28 months, 16 focal testicular lesions (median lesion size, 24 mm; range, 14-48 mm) in 14 patients (median age, 49 years; range, 18-81 years) were examined. Lesions were oval (n = 14), wedge shaped (n = 1), or involved the entire testis (n = 1). Lesions were isoechoic (n = 1), hypoechoic (n = 4), or of mixed echogenicity (n = 11). Color Doppler ultrasound flow was not clearly depicted in 13 lesions but was present in three lesions, with contrast-enhanced ultrasound concordant with color Doppler ultrasound, showing unequivocal absence of vascularity and increased flow, respectively. In the avascular lesions, rim enhancement (n = 6), vascular projections (n = 4), and irregular (n = 10) and smooth (n = 2) borders were documented. The observers identified infarction (n = 9), abscess (n = 4), orchitis (n = 1), and tumor (n = 2). Histologic examination (seven lesions in five patients) confirmed infarction, abscess formation, and seminoma; follow-up ultrasound confirmed resolution for eight patients. Contrast-enhanced ultrasound is a useful adjuvant to color Doppler ultrasound examination of a focal lesion in the testis ipsilateral to epididymitis to improve the characterization of nonvascularized tissue.