Pyocele
Background
A purulent collection of fluid surrounding the testicle (in the potential space of the tunica vaginalis). Characteristically it contains significant debris and septations unlike a hydrocele.
Clinical Features
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
Workup
- Testicular ultrasound - will reveal characteristic debris and septations within an existing hydrocele
- CT imaging of the abdomen and pelvis with IV contrast is only needed if associated Fournier gangrene is suspected
Diagnosis
- Diagnosis will be made by testicular ultrasound
Management
- Urology consult for followup and coordination of surgical drainage
- Most can have a trial of oral antibiotics outpatient prior to surgical drainage
- Ciprofloxacin 500mg PO twice daily x 10 days or Cefpodoxime 200mg PO twice daily x 10 days