Radiological patterns of incidental epididymitis in mild-to-moderate COVID-19 patients revealed by colour Doppler ultrasound

Abstract

The testis is a potential target organ for SARS-CoV-2 infection. Our study intended to investigate any testicular involvement in mild-to-moderate COVID-19 men. We conduct a cross-sectional study in 18 to 55-year-old men hospitalised for confirmed COVID-19. A senior radiologist executed the ultrasound with multi-frequency linear probe in all participants, regardless of any scrotal complaints. Exclusion criteria involved any situation that could impair testicular function. Statistical analysis compared independent groups, classified by any pathological change. Categorical and numerical outcome hypotheses were tested by Fisher's Exact and Mann-Whitney tests, using the Excel for Mac, version 16.29 (p < .05). The sample size was 26 men (mean 33.7 ± 6.2 years; range: 21-42 years), all without scrotal complaints. No orchitis was seen. Eleven men (32.6 ± 5.8 years) had epididymitis (42.3%), bilateral in 19.2%. More than half of men with epididymitis displayed epididymal head augmentation > 1.2 cm (p = .002). Two distinct epididymitis' patterns were reported: (a) disseminated micro-abscesses (n = 6) and (b) inhomogeneous echogenicity with reactional hydrocele (n = 5). Both patterns revealed increased epididymal head, augmented Doppler flow and scrotal skin thickening. The use of colour Doppler ultrasound in mild-to-moderate COVID-19 men, even in the absence of testicular complaints, might be useful to diagnose epididymitis that could elicit fertility complications.

Keywords: COVID-19; SARS-CoV-2; epididymitis; testis; ultrasound.

FIGURE 1

SARS‐COV 2 subclinical epididymitis pattern #1: Epididymal head enlargement (arrow) with inhomogeneous echogenicity and increased colour Doppler blood flow. Marked hypoechogenic small areas with peripherical Doppler vascularization indicating micro‐abscess (arrowhead). Reactional oedema and thickness of the scrotum wall as well (asterisk)

FIGURE 2

SARS‐COV 2 subclinical epididymitis pattern #2: Epididymal head enlargement (arrow) with marked inhomogeneous echogenicity and increased colour Doppler blood flow. Reactional hydroceles are associated (asterisk), oedema and thickness of the scrotum wall as well (arrowhead)

FIGURE 3

Normal epidydimal pattern: Small triangular epididymal head (asterisk), virtual body, and the tail (arrow) followed by vas deferens (arrowhead)

FIGURE 4

Bacterial classic epididymitis pattern: Epididymal head, body and tail enlargement (arrow) with inhomogeneous echogenicity and increased colour Doppler blood flow. Small marked hypoechogenic areas with peripherical Doppler vascularization indicating micro‐abscess (arrowhead). Reactional hydroceles associated (asterisk)