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The Use of Color Doppler Ultrasound (CDUS) in the Evaluation and Treatment of Epididymitis in a University Based Health Care System
Chad R Tracy, Raymond Costabile
University of Virginia, Charlottesville, VA
Introduction: Scrotal ultrasound is not presently recommended in the CDC guidelines for evaluation of epididymitis. Our study evaluates the use of scrotal Color Doppler Ultrasound (CDUS) in patients with clinically diagnosed epididymitis across multiple specialties at a single academic institution.
Methods: From 1999 to 2005, 870 patients were diagnosed with epididymitis. Extensive review identified 480 patients with new onset epididymitis, of which 205 (42.7%) underwent scrotal ultrasound.
Results: 69% (142/205) of men with the clinical diagnosis of epididymitis had ultrasound characteristics consistent with epididymitis. 52% of the men under the age of 30 years underwent scrotal ultrasound compared to 38% of men over 30 years (p<0.01). Patients presenting to the emergency room were more likely to undergo scrotal ultrasound than patients presenting to family practice or internal medicine clinics (57% vs. 17%, p<0.001). Ultrasound characteristics most frequently associated with clinical epididymitis were a thickened scrotal wall (84.2%), abnormal epididymal echotexture (74%), increased epididymal vascularity (72.9%), and an enlarged epididymis (71.5%). Antibiotics were used for treatment in 95% of patients undergoing CDUS and 96% of patients without CDUS. Patients with normal scrotal ultrasounds were treated with antibiotics as often as those with ultrasounds positive for epididymitis (95% vs. 96%).
Conclusions: Ultrasound as a diagnostic adjunct to the clinical diagnosis of epididymitis is of little value. Treatment was not significantly altered by ultrasound findings. The use of CDUS in patients with an acute scrotum should be reserved for distinguishing spermatic cord torsion from epididymitis when the clinical picture is uncertain
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