Case Study - June 2009

This is the scrotal ultrasound scan of a 21-year-old man who developed a painful, swollen left testis 7 days after an episode of bilateral parotitis.

  1. What does the scan show and what is the most likely diagnosis?
  2. How might the diagnosis be confirmed?
  3. What is the treatment?
  4. What is the long-term prognosis

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. There is marked inflammation and vascularity of the left epididymis with increased vascularity in the left testis. The right testis (not shown) is normal. The most likely diagnosis is epididymo-orchitis secondary to mumps
  2. Mumps serology will confirm the diagnosis; in this patient, it was strongly positive. The serum amylase rose to 500 but returned to less than 250 within 48hr, suggesting additional involvement of the pancreas (pancreatitis)
  3. There is no specific treatment for mumps orchitis but, in view of the florid epididymitis, he was commenced on Ofloxacin & Doxycycline. He remained pyrexial for 4 days despite antibiotic therapy.
  4. 30% of males with mumps develop orchitis although this is rare in children before the age of 10. It usually occurs 4-7 days after the parotitis and, in one third of affected patients, may progress to testicular atrophy. If the orchitis is bilateral, there is a significant risk of infertility

Further comments
Females may also develope similar problems with bilateral oophoritis following mumps parotitis.

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