title: Acute Epididymo-orchitis-Related Global Testicular Infarction: Clinical and Ultrasound Findings With an Emphasis on the Juxta-epididymal String-of-Bead Sign.
abstract: Acute epididymo-orchitis (AEO)-related global testicular infarction (GTI) is rare. We report herein the clinical and ultrasound findings of 6 patients with AEO-related GTI. Seventeen patients with torsion-related GTI were also reviewed and compared. The echotexture of AEO-related GTI ranged from mildly inhomogeneous to diffuse heteroechoic, depending on the severity of testicular necrotic changes. All of the patients showed a juxta-epididymal string-of-bead pattern on color Doppler ultrasound, which was ascribed to patent arteries (5/6, 87%) and collateral vessels (1/6, 13%) in the tunica albuginea. There were no significant differences in age, laterality, leukocyte count, testicular volume ratio (infarcted/normal), frequencies of heteroechoic testicular parenchyma, scrotal skin thickening, and hydrocele between the 2 groups. However, the left testis was predominantly affected in both groups. Compared with torsion-related GTI, patients with AEO-related GTI had significantly longer duration from scrotal pain onset to surgery (13.5 ± 5.2 vs 2.6 ± 2.0 days, P < 0.001), a higher level of serum C-reactive protein (110.0 ± 82.0 vs 41.2 ± 35.9 mg/dL, P = 0.013), a higher frequency of the juxta-epididymal string-of-bead sign (100% vs 12%, P < 0.001), and a lower frequency of the whirlpool/knot sign (0% vs 88%, P = 0.002). Although the testis in AEO-related GTI may appear variable from mildly to extensively heteroechoic on gray-scale ultrasound, this unusual disease can be characterized by an avascular testis with a juxta-epididymal string-of-bead sign on color Doppler ultrasound.
authors.affiliation: *Departments of Radiology and †Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; ‡Department of Biomedical Engineering, I-Shou University; and §Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
authors.forename: Ching-Di
authors.initials: CD
authors.lastname: Chang
authors.forename: Jui-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Yen-Ta
authors.initials: YT
authors.lastname: Chen
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Lee
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002648:Child; D004822:Epididymis / Q000000981:diagnostic imaging; D004823:Epididymitis / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007238:Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009920:Orchitis / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult