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Differential Diagnosis of Focal Epididymal Lesions With Gray Scale Sonographic, Color Doppler Sonographic, and Clinical Features

Departments of Radiology (D.M.Y., S.H.K., H.N.K., J.H.K., T.S.S., H.Y.H., H.S.K.) and Pathology (H.C.), Gachon Medical School, Gil Medical Center, Incheon, South Korea.

Address correspondence and reprint requests to Dal Mo Yang, MD, Department of Radiology, Gachon Medical School, Gil Medical Center, 1198 Guwol-Dong, Namdong-Gu, Incheon 405-760, South Korea.

Objective. To determine whether focal epididymal lesions can be differentiated on gray scale sonographic, color Doppler sonographic, and clinical features. Methods. This was a retrospective analysis of 60 focal epididymal lesions in 57 patients. Focal epididymal lesions were classified into 3 groups: nonspecific epididymitis (n = 43), tuberculous epididymitis (n = 10), and benign epididymal masses (n = 7). The following gray scale sonographic, color Doppler sonographic, and clinical features were analyzed: size, location, echogenicity, and heterogeneity of the lesion; hypoechoic or hyperechoic rim presence; hydrocele presence; degree of blood flow in the lesion; patient’s age; duration of symptoms; and scrotal tenderness. Results. Lesions were larger in patients with tuberculous epididymitis than in those with either nonspecific epididymitis (P = .007) or benign epididymal masses (P = .0017). The hypoechoic or hyperechoic rim of the lesion was more common in patients with benign epididymal masses than in those with nonspecific epididymitis (P = .002). The degree of blood flow in the lesion was greater in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P = .0019) or benign epididymal masses (P < .001). The duration of symptoms was shorter in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P = .0092). The frequency of scrotal tenderness was higher in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P < .001). Conclusions. Gray scale sonographic, color Doppler sonographic, and some clinical features may be helpful for differential diagnosis of focal epididymal lesions.

Key Words: Doppler sonography • epididymal tumors • epididymis • epididymitis • sonography

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