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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 258-260

Tubular ectasia of bilateral epididymis in a postvasectomy patient: Sonography, doppler, and strain elastography appearance


Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission05-Feb-2019
Date of Decision15-Apr-2019
Date of Acceptance27-Jun-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Bharat Lohchab
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_36_19

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  Abstract 


Tubular ectasia of epididymis is a benign condition affecting patients predominantly in the age group of 50–60 years. It is a cystic dilatation of tubules of epididymis with stippled appearance appearing hypovascular on color Doppler and demonstrates soft colors on sonoelastography. Here, we present a case report of a 58-year-old postvasectomy male patient who presented with complaints of dull-aching pain and the palpable lump in the scrotum for 10 months. Subsequent ultrasound imaging demonstrated anechoic dilated cystic tubular structures in bilateral epididymis suggesting tubular ectasia. Doppler and sonoelastography helped in confirming the diagnosis.

Keywords: Ectasia, elastography, vasectomy


How to cite this article:
Lohchab B, Phatak S, Deshpande S. Tubular ectasia of bilateral epididymis in a postvasectomy patient: Sonography, doppler, and strain elastography appearance. J Datta Meghe Inst Med Sci Univ 2019;14:258-60

How to cite this URL:
Lohchab B, Phatak S, Deshpande S. Tubular ectasia of bilateral epididymis in a postvasectomy patient: Sonography, doppler, and strain elastography appearance. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 May 28];14:258-60. Available from: http://www.journaldmims.com/text.asp?2019/14/3/258/283587




  Introduction Top


Testes are male reproductive organ or male gonad. Its main function is spermatogenesis and androgen release into the body. Testis consists of multiple coiled tubular structures called seminiferous tubules which act as a site for sperm production. Sperms formed are released into the lumen of seminiferous tubules and travel to straight tubules before reaching rete testis. Further sperms reach into multiple efferent ductules to exit testis and tunica albuginea to enter epididymis where maturation of sperm takes place. Finally, mature sperms enter vas deferens and reach the ejaculatory duct. Any obstruction of ductus deferens can cause slow progressive accumulation of sperms which raises pressure on tenuous tubules of the epididymis, leading to their dilatation and cystic change which is referred to as tubular ectasia. One of the most common causes of vas deferens obstruction is vasectomy. Almost half of the patients develop ectasia after a decade postvasectomy.[1] Ultrasound can detect these characteristic ectatic changes of the epididymis.[2]


  Case Report Top


A 58-year-old male patient came with mild dull-aching pain and the palpable lump in the right hemiscrotum for 10 months. There was a history of vasectomy 8 years ago. Laboratory investigations were within the normal limits. On clinical examination, there was soft swelling noted in the right inguinal region which showed cough impulse suggesting inguinal hernia. Both testes were nontender. Soft palpable mass was felt around the right testis. Left hemiscrotum was enlarged and was transillumination positive suggesting hydrocoele. Further, ultrasound examination revealed dilated tubular cystic structures with stippled appearance in the region of the head, body, and tail region of the right epididymis [Figure 1] and head of the left epididymis [Figure 2] suggesting tubular ectasia of the epididymis. Color Doppler showed no flow within lesion [Figure 3]. On strain elastography demonstrated soft colors (green, red) in the region of epididymis [Figure 4] suggesting benign pathology. Mild left-sided hydrocoele was also noted [Figure 5]. The right testis was relatively smaller in size than left testis.
Figure 1: Ultrasound of the right testis show mildly bulky epididymis with anechoic dilated cystic structures and speckled appearance noted in the region of the head, body, and tail of right epididymis posterior to testis

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Figure 2: Ultrasound of the left testis show enlarged head of left epididymis with dilated tubular structures and cystic spaces within

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Figure 3: Doppler ultrasound of the right testis shows no color flow in dilated anechoic cystic lesions of the right epididymis

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Figure 4: Strain elastography of the right hemiscrotum demonstrates soft colors (green and red) suggesting benign pathology of the right epididymis

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Figure 5: Ultrasound of the left hemiscrotum shows hydrocoele

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  Discussion Top


Vasectomy has been one of the most frequently done procedures for male sterilization and family planning. Almost 1/3rd of patients develop prolonged dull-aching pain many years after vasectomy.[3] These changes which develop after vasectomy are thought to develop due to long-standing accumulation of sperms in tubules of the epididymis which case tubules to dilate leading to ectasia.[4] Tubular ectasia in the epididymis is considered as cystic dilatation of tubules or tubular structures with a stippled appearance.[5] Tubular ectasia is one of the few benign conditions affecting epididymis. It usually affects patients in the age group of 50–60 years. On ultrasonography, it is seen as anechoic dilated tubular structures seen posterior to testis with echoes which is consistent with stippled appearance.[6] These dilated structures may show a connection with tubules of the epididymis.[7] One of the most common differentials of tubular ectasia is varicocele which can be differentiated by color Doppler imaging which shows no flow in case of tubular ectasia.[8] Sonoelastography helps to differentiate benign and malignant testicular masses.[9] On real-time sonoelastography, soft colors were observed, which suggest a benign pathology.[10] On magnetic resonance imaging, tubular ectasia of epididymis show increased size and raised T1 signal intensity.[11]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wosnitzer MS, Goldstein M. Obstructive azoospermia. Urol Clin North Am 2014;41:83-95.  Back to cited text no. 1
    
2.
Ammar T, Sidhu PS, Wilkins CJ. Male infertility: The role of imaging in diagnosis and management. Br J Radiol 2012;85:S59-68.  Back to cited text no. 2
    
3.
McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Chronic testicular pain following vasectomy. Br J Urol 1992;69:188-91.  Back to cited text no. 3
    
4.
Tartar VM, Trambert MA, Balsara ZN, Mattrey RF. Tubular ectasia of the testicle: sonographic and MR imaging appearance. AJR Am J Roentgenol 1993;160:539-42.  Back to cited text no. 4
    
5.
Ishigami K, Abu-Yousef MM, El-Zein Y. Tubular ectasia of the epididymis: A sign of postvasectomy status. J Clin Ultrasound 2005;33:447-51.  Back to cited text no. 5
    
6.
Kulkarni AR, Tinmaswala MA, Shetkar SV. Ultrasound spectrum of tubular ectasia of rete testis and epididymis: Emphasis on early detection. J Integr Neph Androl 2017;4:14.  Back to cited text no. 6
    
7.
Nair R, Abbaraju J, Rajbabu K, Anjum F, Sriprasad S. Tubular ectasia of the rete testis: A diagnostic dilemma. Ann R Coll Surg Engl 2008;90:W1-3.  Back to cited text no. 7
    
8.
Weiss AJ, Kellman GM, Middleton WD, Kirkemo A. Intratesticular varicocele: Sonographic findings in two patients. AJR Am J Roentgenol 1992;158:1061-3.  Back to cited text no. 8
    
9.
Shaaban MS. Use of strain sonoelastography in differentiation of focal testicular lesions. Egypt J Radiol Nucl Med 2017;48:485-91.  Back to cited text no. 9
    
10.
Aigner F, de Zordo T, Pallwein-Prettner L, Junker D, Schäfer G, Pichler R, et al. Real-time sonoelastography for the evaluation of testicular lesions. Radiology 2012;263:584-9.  Back to cited text no. 10
    
11.
McCammack KC, Aganovic L, Hsieh TC, Guo Y, Welch CS, Gamst AC, et al. MRI of the epididymis: Can the outcome of vasectomy reversal be predicted preoperatively? AJR Am J Roentgenol 2014;203:91-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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