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If the infection involves the ipsilateral testis, there may be four sonographic patterns present: 1) a diffusely enlarged, heterogeneously hy-poechoic testis (Fig 2, 3); 2) a diffusely en-larged homogenously hypoechoic testis; 3) a nodular enlarged, heterogeneously hypoechoic testis; 4) a miliary pattern of multiple small hypoechoic nodules in an enlarged testis. Doppler ultrasound has value to determine vascular flow. Epidi-dymo-orchitis usually results in increased vascular perfusion (Fig 4). The presence of vascular flow can exclude testicular isch-emia, which is associated with testicular torsion. Other ultrasonographic findings include thickened scrotal skin and tunica albuginea, hydrocele and scrotal abscess (Fig 5). Scrotal calcification and sinus tract formation are a diagnostic clue for TBEO (Chung et al, 1997). Sonography, as a non-invasive technique, plays an important role in the diagnosis of TBEO. It can help to avoid an unnecessary orchidectomy. Ultrasonography was performed in only 4 cases in our series. Further studies of cases utilizing ultrasonography may be neces-sary in order to determine its role in the diagnosis of TBEO among Thai patients.
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