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Background: Epididymo-orchitis is the inflammation of epididymis leading to testicular involvement. Scrotal abscess is complication of epididymo-orchitis and if this is associated with early torsion then the diagnosing it always poses a challenge for the radiologist. First line of imaging in these cases is always ultrasonography (USG) and color flow imaging (CFI). This shows the similar appearance like many other pathologies and magnetic resonance imaging (MRI) is helpful in differentiating these pathologies. Case report: We report 32 years old male who reported with the left side scrotal swelling and pain with preceding febrile illness two weeks back. USG and CFI had shown swollen left testis with no flow within it. The peritesticular region and spermatic cord was showing abundant flow. Contrast MRI had revealed no enhancement of the left testis with abundant enhancement of the peritesticular region. The diagnosis of Epididymo-orchitis with testicular infarct / abscess was made. The patient was managed surgically with orchiectomy. Conclusion: Epididymo-orchitis is usually diagnosed when the increased testicular blood flow is seen in CFI with other features. But with the help of combination of USG, CFI and MRI, the exact underlying condition of epididymo-orchitis leading to early testicular ischemia was diagnosed. MRI showed non enhancement of the left testis along with abscess formation. The case was treated with broad spectrum antibiotics on initial visit followed by orchiectomy once testicular ischemia ensued.

Epididymo-orchitis Masquerading as Torsion in Scrotal Swelling Case: Radiologist’s Dilemma for the Diagnosis?