eMedicine Specialties > Emergency Medicine > Genitourinary

Orchitis: Differential Diagnoses & Workup

Author: Mark B Mycyk, MD, Associate Professor, Department of Emergency Medicine, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2009

Differential Diagnoses

Epididymitis
Hernias
Testicular Torsion

Other Problems to Be Considered

Testicular tumor
Reactive hydrocele
Scrotal pyocele
Torsion of the testicular appendage

Workup

Laboratory Studies

  • Laboratory tests are not helpful in making the diagnosis of orchitis in the ED.
  • Diagnosing mumps orchitis can be comfortably made based on history and physical examination alone. However, if epididymo-orchitis is a concern, urine dip, urinalysis, and urethral cultures should be obtained.
  • Diagnosing mumps orchitis can be confirmed with serum immunofluorescence antibody testing.

Imaging Studies

  • Color Doppler ultrasonography has become the imaging test of choice for the evaluation of an acute scrotum.1,2

    • Because orchitis often presents as acute edema and pain of the testicle, ruling out testicular torsion is critical.
    • Often the history and the physical examination are enough; however, as an adjunct, ultrasonography is highly sensitive for ruling out testicular torsion and for demonstrating inflammation of the testis or the epididymis.3,4

Procedures

  • If torsion is likely or if several hours have passed before the patient arrives in the ED, operative exploration is indicated.
  • Orchitis complicated by a reactive hydrocele or pyocele may require surgical drainage to reduce the pressure in the tunica.

More on Orchitis

Overview: Orchitis
Differential Diagnoses & Workup: Orchitis
Treatment & Medication: Orchitis
Follow-up: Orchitis
References
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References

  1. Herbener TE. Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound. Oct 1996;24(8):405-21. [Medline].

  2. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. Mar 2004;42(2):349-63. [Medline].

  3. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. Jan 2001;8(1):90-93. [Medline].

  4. Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Hollwarth ME. Management of acute scrotum in children--the impact of Doppler ultrasound. J Pediatr Surg. Aug 2006;41(8):1377-80. [Medline].

  5. Tiemstra JD, Kapoor S. Evaluation of scrotal masses. Am Fam Physician. Nov 15 2008;78(10):1165-70. [Medline].

  6. Basekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF. Mumps epididymo-orchitis: sonography and color Doppler sonographic findings. Abdom Imaging. May-Jun 2000;25(3):322-5. [Medline].

  7. Casella R, Leibundgut B, Lehmann K, Gasser TC. Mumps orchitis: report of a mini-epidemic. J Urol. Dec 1997;158(6):2158-61. [Medline].

  8. Cook JL, Dewbury K. The changes seen on high-resolution ultrasound in orchitis. Clin Radiol. Jan 2000;55(1):13-8. [Medline].

  9. Corbett HJ, Simpson ET. Management of the acute scrotum in children. ANZ J Surg. 2002;72(3):226-8. [Medline].

  10. Edelsberg JS, Surh YS. The acute scrotum. Emerg Med Clin North Am. Aug 1988;6(3):521-46. [Medline].

  11. Garthwaite MA, Johnson G, Lloyd S, Eardley I. The implementation of European Association of Urology guidelines in the management of acute epididymo-orchitis. Ann R Coll Surg Engl. Nov 2007;89(8):799-803. [Medline].

  12. Gift TL, Owens CJ. The direct medical cost of epididymitis and orchitis: evidence from a study of insurance claims. Sex Transm Dis. Oct 2006;33(10 Suppl):S84-8. [Medline].

  13. Lane TM, Hines J. The management of mumps orchitis. BJU Int. Jan 2006;97(1):1-2. [Medline].

  14. Manson AL. Mumps orchitis. Urology. 2004;36(4):355-8. [Medline].

  15. Masarani M, Wazait H, Dinneen M. Mumps orchitis. J R Soc Med. Nov 2006;99(11):573-5. [Medline].

  16. Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. Mar 2004;88(2):495-518. [Medline].

  17. Shafik A, El-Sibal O, Shafik I. Electro-orchidogram: a non-invasive diagnostic tool in testicular pathologies. Med Sci Monit. Aug 2006;12(8):MT51-5. [Medline].

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Further Reading

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Keywords

orchitis, viral orchitis, bacterial orchitis, epididymo-orchitis, mumps orchitis, testicular pain, testicular swelling, inflammation of the testis, viral mumps infection, epididymitis, testicular atrophy, benign prostatic hypertrophy, BPH, parotitis, testicular edema

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Contributor Information and Disclosures

Author

Mark B Mycyk, MD, Associate Professor, Department of Emergency Medicine, Boston University School of Medicine
Mark B Mycyk, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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