Pyocele: Difference between revisions
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==Background== | ==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. | 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.<ref>Bruner BI. et al. Scrotal pyocele: Uncommon urologic emergency. J Emerg Trauma Shock. 2012 Apr-Jun; 5(2): 206.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Scrotal Pain | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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===Workup=== | ===Workup=== | ||
*[[Testicular ultrasound]] - will reveal characteristic debris and septations within an existing hydrocele | *[[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 | *CT imaging of the abdomen and pelvis with IV contrast is only needed if associated [[Fournier gangrene]] is suspected<ref>Lee C, Henderson SO. Emergency surgical complications of genitourinary infections. Emerg Med Clin N Am. 2003;21:1057–74.</ref> | ||
===Diagnosis=== | ===Diagnosis=== | ||
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*Urology consult for followup and coordination of surgical drainage | *Urology consult for followup and coordination of surgical drainage | ||
**Most can have a trial of oral antibiotics outpatient prior to 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 | |||
==Disposition== | ==Disposition== | ||
*Close outpatient follow for resolution after antibiotics. | |||
*Admission only waranted in settings of [[sepsis]] or [[Fournier gangrene]] | |||
==See Also== | ==See Also== | ||
Latest revision as of 04:23, 29 October 2022
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.[1]
Clinical Features
- Scrotal Pain
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[2]
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
Disposition
- Close outpatient follow for resolution after antibiotics.
- Admission only waranted in settings of sepsis or Fournier gangrene