Comparison of tuberculous and pyogenic epididymal abscesses: Clinical, gray-scale sonographic, and color Doppler sonographic features

OBJECTIVE. The purpose of this study was to evaluate the capability of clin ical, gray-scale sonographic, and color Doppler sonographic features for di fferentiating tuberculous and pyogenic epididymal abscesses. MATERIALS AND METHODS. Retrospective analysis was performed in 10 cases of tuberculous epididymal abscess and in 13 cases of pyogenic epididymal absce ss. The following clinical, gray-scale sonographic, and color Doppler sonog raphic features were analyzed: patient's age; duration of symptoms; scrotal tenderness; presence of sinus tract; concurrent tuberculosis in other orga ns; location, size, and echogenicity of the abscess; hyperechoic rim; testi cular involvement; hydrocele; and blood flow in the epididymal lesion. RESULTS. Tuberculous epididymal abscess had a longer duration of symptoms ( p = 0.0001) and a lower frequency of scrotal tenderness (p = 0.0048) than p yogenic epididymal abscess. The size of the abscess was larger in tuberculo us epididymal abscess than in pyogenic epididymal abscess (p = 0.0002). The degree of blood flow in the peripheral portion of the abscess was lower in tuberculous epididymal abscess (p = 0.001). The patient's age, location an d echogeninicity of the abscess., presence of sinus tract, hyperechoic rim, testicular involvement, and hydrocele did not differ between the tuberculo us and pyogenic epididymal abscesses. CONCLUSION. Some clinical findings, gray-scale sonography, and color Dopple r sonography were useful in differentiating tuberculous epididymal abscess from pyogenic epididymal abscess. The presence of long-term scrotal swellin g without tenderness and a lower degree of blood flow in the peripheral por tion of a large abscess are suggestive of tuberculous epididymal abscess.