Online Journal
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Journal of Medical Ultrasonics

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2017 - Vol.44

Vol.44 No.03

Case Report(症例報告)

(0289 - 0293)


Tuberculous granulomatous epididymo-orchitis mimicking a testicular tumor: ultrasound findings

成田 啓一1, 金田 智2, 陣崎 雅弘1

Keiichi NARITA1, Satoshi KANEDA2, Masahiro JINZAKI1

1慶應義塾大学医学部放射線科学教室(診断), 2東京都済生会中央病院放射線科

1Department of Diagnostic Radiology, Keio University School of Medicine, 2Department of Radiology, Saiseikai Central Hospital

キーワード : tuberculous granulomatous epididymo-orchitis, genitourinary tuberculosis, ultrasonography


A 72-year-old male with indolent scrotal swelling of one month’s duration was admitted to urology. Scrotal ultrasonography showed abnormalities of the right epididymis and testis. An enlarged epididymal head was heterogeneously hypoechoic, and the border of the right epididymis and testis was ill-demarcated because an epididymal hypoechoic lesion spread into the testis. A sonogram of the right testis revealed multiple small hypoechoic nodules. In addition, there were moderate hydrocele, thick tunica albuginea, and scrotal wall edema. Color Doppler imaging revealed a few signals localized to the periphery of the epididymis. We suspected a right testicular tumor and performed high orchidectomy. Pathologically, there were granulation tissues with abscess, caseation necrosis, and Langhans giant cells. The patient had no history of pulmonary tuberculosis, and Mycobacterium tuberculosis was not detected by Ziehl-Neelsen stain nor isolated from the sputum and urine. We ultimately diagnosed tuberculous granulomatous epididymo-orchitis based on positive interferon-gamma release assays and computed tomography findings of old tuberculous pleurisy. It is often difficult to differentiate this disease from testicular tumor, but the presence of an enlarged epididymis, multiple small hypoechoic nodules in the testis, and Doppler signals localized at the periphery may be useful in making an accurate diagnosis. Findings that suggest inflammatory disease rather than a testicular tumor might be also helpful: scrotal wall thickening, thick tunica albuginea, and hydrocele.