Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis

Abstract

A male patient was referred to radiology with scrotal pain and swelling. Prior to diagnosis, the patient had three sonograms for scrotal swelling, which progressed to a discharging scrotal sinus. At the second scan, a risk factor of past history of pulmonary tuberculosis (PTB) was noted. The first sonogram showed findings suggestive of left epididymitis, the second sonogram showed possible primary testicular tumor or epididymal tuberculosis (EPTB), the third sonogram showed epididymal pathology extending to involve the tunica vaginalis and scrotal wall leading to a sinus tract formation, and the fourth sonogram was normal. This case highlights the sonographic findings during progression of EPTB and the differential diagnosis to consider in such cases. It is a useful educational aid for radiologists and sonographers when evaluating the role of sonography in the management of a patient with scrotal swelling and discharging scrotal sinus.