A 40 year old male patient presented with the complaints of scrotal pain along with fever.

Ultrasound findings:-

• Testis shows a heterogenous echotexture.
• Epididymis appears bulky & heterogenous with increased vascularity.
• Scrotal wall thickening with small pockets of thick collections.
• Reactive hydrocele.

Colour doppler findings:-

• Increased blood flow within the epididymis & testis.
• On pulsed wave doppler, increased PSV with increased diastolic flow is seen at initial stages. Later stage may show reduced/ absent/ reversed diastolic flow due to parenchymal edema.

Etiology:-

• Bacterial infection (E. coli ) is the most common cause.
• Sexually transmitted diseases such as  gonorrhea or chlamydia.
• Other infections, including mumps virus and rarely, tuberculosis.
• Torsion detorsion sequelae.

Stages of epididymitis on power doppler:-

• Stage 1: Acute stage in which there is increased diastolic flow.
• Stage 2: Absent diastolic flow.
• Stage 3: Diastolic reversal.
• Stage 4: Total cut off vascularity.

Complications:-

• Testicular ischemia.
• Testicular infarction.
• Epididymal abscess.
• Testicular abscess.