The Teaching Point

This case stresses the importance of using color Doppler imaging and obtaining spectral waveforms when performing ultrasound examinations of the scrotum for epididymo-orchitis. When reversal of diastolic flow is identified, it is important to promptly alert the ordering physician of the sign concerning for impending testicular infarction as it may acutely alter their treatment plan.






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From the manuscript

Significance of Reversal of Diastolic Blood Flow in the Evolution of Testicular Infarction as a Complication of Epididymo-Orchitis

Free full text article: Significance of Reversal of Diastolic Blood Flow in the Evolution of Testicular Infarction as a Complication of Epididymo-Orchitis

Abstract
We report a case of a 50-year-old male who presented to the Emergency Department and was diagnosed with epididymo-orchitis. Sonographic evaluation of the testicle initially showed a normal, low resistance color Doppler waveform. The patient was admitted to the hospital. A follow up sonogram two days later demonstrated reversal of diastolic arterial flow on Pulse-Wave color Doppler imaging. Reversal of diastolic blood flow in testicular color Doppler sonography is a sign of impending infarction. On hospital day 6, the patient had a follow up ultrasound which demonstrated infarction of the testicle. Pathology confirmed the diagnosis and the tissue culture grew E. coli and Candida Albicans. This case documents the rapid progression of epididymo-orchitis with a normal spectral waveform to testicular infarction with reversal of diastolic blood flow on color Doppler imaging as a sign of impending infarction.






References



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