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.
- What does the scan show and what is the most likely diagnosis?
- How might the diagnosis be confirmed?
- What is the treatment?
- 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:
- 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
- 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)
- 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.
- 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.