A scrotal pyocele is a purulent collection of fluid surrounding the testicle in the potential space of the tunica vaginalis and can be distinguished from a hydrocele by presence of internal echoes consistent with debris, septations, or loculations. A scrotal pyocele is typically a sequela of adjacent infection, such as epididymo-orchitis or rupture of a testicular abscess. Less commonly, it can be due to tracking of an intraperitoneal infection through the inguinal canal. The cellular debris may also be blood, such as in a hematocele, but there is usually a history of antecedent trauma in this setting.
Management and Disposition
Urologic consultation should be obtained; surgical drainage and broad-spectrum antibiotics are indicated. Severe cases may compromise viability of the adjacent testicle, and an orchiectomy may be required. In cases where a deeper infection is suspected, such as Fournier gangrene, obtain early IV contrast-enhanced computed tomography (CT) imaging of the pelvis.
Scrotal Pyocele. An adult with a pyocele showing (A) swelling of the left hemiscrotum, and (B) ultrasound findings of a fluid collection in the scrotum with internal septations and debris consistent with a pyocele. (Photo contributor: Lawrence B. Stack, MD.)
Internal echoes in fluid surrounding the testicle indicate either cellular debris from pus (pyocele) or from blood (hematocele).
Obtain urologic consultation for pyoceles.
Consider deeper infection such as Fournier gangrene, and obtain CT imaging if suspected.