What is a pyocele, and what are its cross sectional imaging features?
A pyocele is a collection of pus within the scrotum adjacent to the testicle located between the visceral and parietal layers of the tunica vaginalis. It may occur as a complication of trauma, surgery, or epididymo-orchitis.
On cross-sectional imaging, increased echogenicity, increased attenuation, or variably increased T1-weighted and variably decreased T2-weighted signal intensity of the fluid may be seen. Internal septations, fluid-debris levels, and/or foci of gas (with increased echogenicity, dirty posterior acoustic shadowing, and reverberation artifacts on US; very low attenuation on CT; and very low signal intensity on MRI) may also be visualized within the fluid (see Figure 39-13 ). A thickened wall with increased blood flow on Doppler US and increased enhancement on CT or MRI may also be visualized.