Orchitis Workup

  • Author: Mark B Mycyk, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: May 5, 2010
 

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.
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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]
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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.
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Proceed to Treatment & Management
 
 
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 College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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

  2. Yagil Y, Naroditsky I, Milhem J, Leiba R, Leiderman M, Badaan S, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. Jan 2010;29(1):11-21. [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. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. Apr 1 2009;79(7):583-7. [Medline].

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

  8. 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].

  9. 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].

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

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

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

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

  14. 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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