The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report.

BACKGROUND: Genitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male. CASE PRESENTATION: A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department. CONCLUSIONS: Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.

Morphology of the epididymal duct of the domestic pig (Sus scrofa domesticus).

The study provides a general overview of the morphology of the epididymal duct in pigs. Four epididymides from two sexually mature boars were dissected into 32 segments and examined histologically. Duct lumen and wall thickness were measured and relative surface area of different components was assessed by Chalkley's random hit method. The epithelial lining was characterized at X1000. Lumen diameter and wall thickness of efferent ductules averaged 177 and 30 µm, respectively. Of the epididymal duct from caput to distal corpus the luminal diameter was 332 µm, with a narrower section in the proximal corpus. Wall thickness averaged 70 µm. In the cauda, luminal diameter and wall thickness increased to 717 and 751 µm, respectively. The epithelial lining of the efferent ductules consists of a single layer of columnar cells with average height 21 µm. The lining of the epididymal duct consists of ciliated, pseudo-stratified columnar epithelium composed of "basal cells" and "principal cells." Particularly tall principal cells (96 µm) were found in the proximal caput. Height decreased to 40 µm at the distal cauda. Microvilli from principal cells were 14-17 µm long in the distal caput but decreased to 5 µm in the distal cauda. The epithelial lining was folded in the proximal caput and more so in the distal cauda. Secretory granules (epididymosomes) were present in small amounts in efferent ductules and epididymal duct; the largest quantities occurred in the distal cauda. Leukocytes were present throughout the duct, albeit in insignificant numbers. Chalkley's random hit method showed rapid spermatozoan transport through efferent ductules and proximal caput in large amounts of fluid. Sperm concentration increased due to fluid resorption in the proximal caput, was highest from caput flexure to proximal cauda and decreased at the caudal flexure, indicating secretory activity.

In vivo dynamic volumetric imaging of mouse testis and epididymis with optical coherence tomography†.

The implementation of live imaging in reproductive research is crucial for studying the physiological dynamics. Sperm transport is a highly dynamic process regulated by tubular contractions and luminal flows within the male reproductive tract. However, due to the lack of imaging techniques to capture these dynamics in vivo, there is little information on the physiological and biomechanical regulation of sperm transport through the male reproductive tract. Here, we present a functional in vivo imaging approach using optical coherence tomography, enabling live, label-free, depth-resolved, three-dimensional, high-resolution visualization of the mouse testis and epididymis. With this approach, we spatiotemporally captured tubular contractility in mouse testis and epididymis, as well as microstructures of these reproductive organs. Our findings demonstrated that the contraction frequency varies significantly depending on the epididymal regions, suggesting the spatial regulation of epididymal contractility. Furthermore, we implemented quantitative measurements of the contraction wave and luminal transport through the epididymal duct, revealing the physiological dynamics within the male reproductive tract. The results show that the contraction wave propagates along the epididymal duct and the wave propagation velocity was estimated in vivo. In conclusion, this is the first study to develop in vivo dynamic volumetric imaging of the male reproductive tract, which allows for quantitative analysis of the dynamics associated with sperm transport. This study sets a platform for various studies investigating normal and abnormal male reproductive physiology as well as the pharmacological and environmental effects on reproductive functions in mouse models, ultimately contributing to a comprehensive understanding of male reproductive disorders.

Characterizing Normal Variant [68Ga]Ga-FAPI-46 Uptake in the Epididymis.

The biodistribution of fibroblast activation protein inhibitor (FAPI) PET tracers includes the kidneys, bladder, uterus, breast, muscles, and bone marrow. We describe its occasional uptake patterns in the epididymis. Methods: Epididymal [68Ga]Ga-FAPI-46 uptake was retrospectively analyzed in 55 PET/CT studies of 55 men. Uptake intensity (SUV), pattern (diffuse, focal, or multifocal), laterality, and location (epididymal head with or without body/tail) were analyzed. Electronic medical records were reviewed to determine the presence of epididymis-related disease. Results: Epididymal [68Ga]Ga-FAPI-46 uptake was observed in 8 of 55 (15%) subjects, with bilateral epididymal head uptake in all cases and epididymal body/tail uptake in 6 of 8 (75%) cases, 5 of 6 (83%) bilaterally and 1 of 6 (17%) unilaterally. The average SUVmax was greater in the epididymal heads than in the epididymal bodies/tails, with an SUVmax of 4.1 versus 3.0 (P < 0.001). No subject had epididymal disease related to the uptake. Conclusion: [68Ga]Ga-FAPI-46 uptake in the epididymis occurs occasionally and does not appear related to epididymal disease.

Contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis in children: a case series.

PURPOSE: Torsion of the appendix testis or epididymis is a cause of acute scrotum in children. Ultrasonography with color Doppler is the first-choice modality for diagnosis. However, this method requires skill and experience to make a diagnosis with confidence. Recently, contrast-enhanced ultrasonography for diagnosis in various fields has been reported. However, to our knowledge, there has been no report of this method being used to diagnose torsion of the appendix testis or epididymis. The purpose of this study was to retrospectively examine contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis. METHODS: Patients who underwent contrast-enhanced ultrasonography for torsion of the appendix testis or epididymis at our institution between April 2010 and April 2023 were enrolled in this study (n = 12). Contrast-enhanced ultrasonography findings of the affected appendage and the testis parenchyma were examined retrospectively. RESULTS: The parenchyma of the testes was notably enhanced in all the cases. However, 9 of the 12 cases showed that the appendage with torsion was not enhanced at all. In the remaining three cases, only slight enhancement was seen. Nevertheless, it was notably less than that of the parenchyma of the testis. CONCLUSION: Our findings indicated that contrast-enhanced ultrasonography may be an easy and reliable method for diagnosing torsion of the appendix testis or epididymis.

[Primary Leiomyosarcoma of the Epididymis : A Case Report].

A 63-year-old man presented with right scrotal swelling. A physical examination revealed a painless, palpable mass in the right scrotum. The mass was well defined and lobulated. Subsequently, a diagnosis of right epididymal tumor was made, and right high orchiectomy was performed. Hematoxylin-eosin and immunostaining revealed leiomyosarcoma of the epididymis. When a diagnosis of epididymal malignant tumor is made, the standard treatment is radical orchiectomy.

[A Case of Metachronous Rupture of Right Testis and Right Epididymis].

The patient was a 15-year-old male. Four months prior to his visit to our department, he was hit in the right scrotum by a baseball, which caused right scrotal swelling and pain. He visited a urologist who prescribed analgesics. During follow up observation, right scrotal hydrocele appeared and a puncture procedure was performed two times. Four months later, while climbing a rope for strength training, his scrotum became entangled by the rope. He immediately felt right scrotal pain and visited a urologist. Two days later, he was referred to our department for a thorough examination. Scrotum ultrasound revealed right scrotal hydroceles and swollen right cauda epididymis. The patient was treated conservatively with pain control. The next day, the pain did not improve, and surgery was decided since testicular rupture could not be completely ruled out. Surgery was performed on the third day. The caudal portion of the right epididymis was injured approximately 2cm, the tunica albuginea had been ruptured and the testicular parenchyma had escaped. The surface of the testicular parenchyma was covered with a thin film, suggesting that 4 months had elapsed since the tunica albuginea injury. The injured area of the epididymis tail was sutured. Subsequently, we removed the remaining testicular parenchyma and restored the tunica albuginea. Twelve months postoperatively, right hydrocele and testicular atrophy were not observed.

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases.

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

An ectopic ureter inserting into epididymis combined with ipsilateral duplex kidney in a boy diagnosed by MRI: report of a rare case.

We present the first case of a right ectopic ureter ending in epididymis combined with an ipsilateral complete duplex kidney, presenting with painless right scrotal mass and demonstrated by magnetic resonance imaging (MRI). The boy was initially diagnosed as right testicular teratoma by ultrasound, and then underwent surgical treatment. Because of recurrence of right scrotal swelling 1 year later, MR scan was performed. MR images with body coil displayed the entire ectopic ureter, and MR images with small surface coil clearly showed anatomic details of right ureteral ectopia into epididymis. Delayed-enhanced MRI showed contrast agent in the right dilated epididymis. The boy finally received the curative right upper pole nephronureterectomy.

Sonography in male infertility: a useful yet underutilized diagnostic tool.

PURPOSE: To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia. METHODS: 30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P < 0.05 was considered significant. RESULTS: Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P < 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P < 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P < 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P < 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively. CONCLUSION: Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.

Epididymal cyst in children.

The terms "epididymal cyst" and "spermatocele" are commonly used to describe the same entity, but, conversely, they are slightly different. Epididymal cyst is a benign mass, and it is more common than previously thought in prepubertal age. Pathogenic mechanisms for epididymal cyst have not been fully clarified yet, even if epididymal cysts have been reported in association with other malformations of the urinary tract or complex syndromes. Epididymal cyst is easily characterized and differentiated from spermatocele using ultrasound imaging. Conservative management constitutes the treatment of choice in the majority of cases, and surgery is recommended only in selected cases. Conclusion: To date, a review on epididymal cyst in childhood is lacking in the literature. Herein, an overview of knowledge about epididymal cyst in children has been carried out with particular attention to differential diagnosis, proper management, and practice guidelines for caregivers of children who may present with an epididymal cyst. What is Known: • Epididymal cyst is a benign sac in the testicles which is usually asymptomatic. • Epididymal cyst is easily diagnosed by ultrasound scans, and it is considered a self-limiting disease in the majority of cases. What is New: • Insight on differential diagnosis between epididymal cyst and spermatocele. • Valuable knowledge on the best management strategy for epididymal cyst and on practice guidelines for parents of children presenting with epididymal cyst.

Paratesticular lesions: Aetiology and appearances on ultrasound.

BACKGROUND: Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities. OBJECTIVE: To describe the abnormalities of the paratesticular space. MATERIALS/METHODS: The paratesticular space contains the epididymis, spermatic cord and the tunica vaginalis cavity and is affected by a variety of inflammatory or tumoral entities. Differential diagnosis based on US criteria is frequently problematic, as the findings are non-specific. RESULTS: Some general rules apply: (i) unlike testicular lesions, extra-testicular entities are usually benign in the adult, (ii) the first steps to accurate diagnosis include careful localization of the lesion and assessment of its consistency (solid or cystic) and (iii) magnetic resonance imaging can be useful for further tissue characterization of lesions suspected to contain fat, but surgical biopsy will often provide the definite diagnosis. Contrast-enhanced ultrasound (CEUS) has been applied with limited experience indicating a narrow role, primarily for the differential diagnosis of echogenic cystic entities and the delineation of a necrotic abscess from a solid neoplasm. DISCUSSION: The various abnormalities are discussed and illustrated. CONCLUSION: This manuscript summarizes the literature on paratesticular lesions and the value of US in diagnosis.

Ageing changes testes and epididymis blood flow without altering biometry and echodensity in dogs.

Senescence leads to deleterious effects in testicular function, sperm quality and fertility in dogs. There, however, are no consistent results of vascular changes in the testes and epididymis during natural ageing in dogs. The aim of this study, therefore, was to compare testes and epididymis blood flow, biometry and echodensity between young and senile dogs. Ten young dogs (1-4 years) and eight senile dogs (over 7 years) were selected and assigned to two experimental groups: Young Group and Senile Group. Dogs were evaluated using testicular and epididymis B-mode (dimensions and echodensity) and Doppler ultrasonography (tissue perfusion parameters and blood flow velocity of the testicular artery). There were no differences between experimental groups for the echographic evaluation of testicular and epididymis parenchyma and biometric variables. The dogs in the Young Group had greater (P = 0.02) testes vascularization score and greater (P = 0.06) testicular artery blood flow velocity than those in the Senile Group. Furthermore, the older dogs had a greater (P = 0.06) pulsatility index of the testicular artery than those in the Young Group. Ageing, therefore, seems to cause natural hemodynamical changes to the testicular artery, resulting in reduced blood flow (ischemia) and tissue damage. Testes and epididymis vascular characteristics, therefore, may represent the causal factors for changes in spermatogenesis and, as a consequence, negatively affect the sperm quality of older dogs. In conclusion, senescence alters testicular artery blood flow and vascularization of the testes, without changing testicular and epididymis ultrasonographic dimensions and echodensity in dogs.

Physiologic prostate-specific membrane antigen-targeted 18F-DCFPyL uptake in the epididymis head newly appreciated on digital PET/CT.

PURPOSE: The published physiological distribution of prostate specific membrane antigen (PSMA) PET ligands includes normal uptake in the lacrimal glands, salivary glands, bowel, liver, spleen, kidneys and parasympathetic ganglia but does not include the epididymis. METHODS: Retrospective review of 134 PSMA-targeted 2-(3-(1-carboxy-5-[(6-[18F]fluoropyridine-3-carbonyl)-amino]-pentyl)-ureido)-pentanedioic acid (18F-DCFPyL) PET/CT scans performed on a latest generation digital scanner for radiotracer uptake in the epididymal head region was correlated with multiple clinical and laboratory factors. RESULTS: Physiologic PSMA radiotracer uptake in the epididymal head region was present in 57% of all subjects, including 29% in those with a total serum testosterone ≤ 5 nmol/L and 65% of patients with serum testosterone > 5 nmol/L, odds ratio of 0.21 (P < 0.01). CONCLUSION: Epididymal head uptake is physiologic and very common on digital PSMA PET/CT and is more frequent in patients with higher serum testosterone levels. The enhanced small structure detection of digital PET/CT is the most likely explanation for the novel visualization of this normal variant.

How common are traumatic injuries to the epididymis? A study of prevalence, imaging appearance, and management implications.

PURPOSE: To evaluate the prevalence of epididymal injuries with scrotal trauma, review imaging appearance, clinical management, and outcomes. METHODS: In this retrospective study, the radiology report database was queried for scrotal ultrasounds containing keywords pertaining to trauma, from 1998 to 2019. Exams with no clinically documented trauma, exams with trauma > 1 year ago, and duplicate exams were excluded. Chart review was conducted for age, trauma mechanism, time interval between trauma and ultrasound, signs of infection, and clinical management. Reports were reviewed to record the presence of scrotal injury, traumatic epididymitis, or epididymal hematoma. Cases with epididymal injury underwent image review. Descriptive statistics, Fisher's exact test, and Mann-Whitney's U test were performed to evaluate for associations between clinical parameters and epididymal injury. RESULTS: Initial search yielded 385 exams. A total of 103 exams met inclusion criteria. Trauma mechanisms included straddle injury (35%), blunt scrotal trauma by ball or other object (29%), assault (28%), penetrating injury (4%), and fall (3%). Sixty-eight patients (66%) had scrotal injury on imaging. Twenty-six (25%) had epididymal injury. Thirteen were isolated to the epididymis, and 13 had associated testicular or extra-testicular findings. There were 12 cases of traumatic epididymitis and 14 epididymal hematomas. All epididymal injuries were managed non-operatively. A total of 7 were prescribed antibiotics, including 1 subject who otherwise had no evidence of infection. CONCLUSION: Epididymal injury is encountered in 25% of scrotal ultrasounds for trauma evaluation. Traumatic epididymitis can be seen in 12%. It is important for radiologists to recognize this entity, as it can be mistaken for infection.