- Author: Nataisia Terry, MD; Chief Editor: Erik D Schraga, MD more...
Laboratory tests are often 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. Diagnosing mumps orchitis can be confirmed with serum immunofluorescence antibody testing.
In sexually active males, urethral cultures and gram stain should be obtained for Chlamydia trachomatis and N gonorrhea. Urinalysis and urine culture should also be obtained.
Obtaining a C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) may also be helpful, because elevations of these are more suggestive of inflammation associated with epididymo-orchitis.
Color Doppler ultrasonography has become the imaging test of choice for the evaluation of an acute scrotum.[2, 3, 4]
Because orchitis often presents as acute edema and pain of the testicle, ruling out testicular torsion is critical. A finding of a normal-sized testicle with decreased flow is suggestive of torsion, whereas a finding of an enlarged epididymis with thickening and increased flow is more suggestive of epididymitis/orchitis.
Often, the history and physical examination are enough to make the diagnosis; however, as an adjunct, ultrasonography is highly sensitive for ruling out testicular torsion and for demonstrating inflammation of the testis or the epididymis.[5, 6]
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.
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