Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epididymitis.
OBJECTIVE
The purpose of this study is to determine the effectiveness of contrast-enhanced ultrasound in evaluating incidental focal testicular lesions in epididymitis.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Radiology, King's College London, King's College Hospital, London, United Kingdom.
Phillip F C
PF
Lung
Ounali S
OS
Jaffer
Maria E
ME
Sellars
Sheshadri
S
Sriprasad
Gordon G
GG
Kooiman
Paul S
PS
Sidhu
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004823:Epididymitis / Q000150:complications*; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology; D013737:Testis / Q000098:blood supply; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride