FIGURE 61.6 Epididymitis Ultrasound image of enlarged epididymis seen on left side of image, testis on right Color Doppler flow ultrasound reveals increased blood flow to inflamed epididymis Orchitis Orchitis is an inflammation or infection of the testis resulting from the extension of epididymitis, rarely as hematogenous spread of a systemic bacterial infection, or following certain viral infections, including mumps Other viruses implicated include adenovirus, Epstein–Barr virus, coxsackievirus, parvovirus, and echoviruses Fortunately, less common since the advent of vaccine against mumps and rare before puberty, orchitis occurs in about 18% of postpubertal boys with mumps parotitis The onset of mumps orchitis occurs to days after parotitis manifests Rarely, it has been reported in the absence of parotitis In 70% of cases, it is unilateral It results in testicular atrophy, but not necessarily sterility, in 50% of affected testes Treatment is supportive with analgesic/anti-inflammatory medications, rest, ice, and support of the scrotum Trauma/Hematocele In children, most trauma to the scrotum results from a direct blow to the perineum or a straddle injury that compresses the testicle against the pubic bone Penetrating injuries are less common, and the small size and greater mobility of the prepubertal testis make testicular injuries rare in this group (see Chapter 108 Genitourinary Trauma )