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Enlarged Perivascular Spaces in Hunter Syndrome
Joseph Junewick, MD FACR
over 10 years ago
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Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 11 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US
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9 year old with 3 day history of scrotal pain.

Case Images




US – Enlarged epididymis with marked hyperemia of the epididymus and testicle.


While acute epididymitis is the most common cause of an acute scrotum in adolescence, it is uncommon in prepubertal males. Patients usually present with pain, swelling and erythema of the affected side; fever and leukocytosis are seen in about half.

Neurogenic bladder, congenital malformations of the urinary tract and systemic infections are risk factors. Coliform bacteria are often responsible for epididymitis. Epididymitis may also be a reaction to viral pathogens; Mycoplasma pneumoniae, enteroviruses, and adenoviruses etiologies should be considered.

Complications of ependidymitis include direct spread of infection to the testicle which can be seen in 20% of cases, abscess and infarction.

On sonography, the epididymus is enlarged and hyperemic, often associated with a reactive hyrocele or pyocele. With involvement of the testicle the echogenicity becomes more heterogeneous and blood flow may be focally or diffusely increased. In prepubescent males, workup should include a urologic evaluation for a genitourinary anomaly.


Aso C, et al. Gray-Scale and Color Doppler Sonography of Scrotal Disorders in Children: An Update. Radiographics 2005; 25:1197-1214.

Banner MP, et al. US-MR Correlation in Pathologic Conditions of the Scrotum. Radiographics 2007; 27:1239-1253.

Dogra VS, et al. Sonography of the Scrotum. Radiology 2003; 227:18-36.


Matthew McElliott, BS

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