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{|class="wikitable" align="right"|+Normal epididymis thickness|-| Head || 10 - 12 mm<ref>[https://books.google.se/books?id=u8ZZd-i_obAC&pg=PA221 Page 221] in: {{cite bookMain|title=Ultrasound Review Ultrasonography of the Abdomen, Male Pelvis & Small Parts|author=Janice Hickey, Franklin Goldberg|publisher=Lippincott Williams & Wilkins|year=1999|isbn=9780397516919}}</ref>|-| Tail || 2 - 5 mm<ref>{{cite web|url=https://sonoworld.com/CaseDetails/Acute_right_epididymitis.aspx?ModuleCategoryId=261|title=Acute right epididymitis|author=Chaitali Shah|website=Sonoworld.com|accessdate=2018-06-26}}</ref>|} Epididymitis and epididymo-orchitis are common causes of acute scrotal pain in adolescent boys and adults. The infection usually begins in the epididymal tail and spreads to the epididymal body and head. Approximately 20% to 40 % of cases are associated with orchitis due to direct spread of infection into the testis.<ref name="MakTzeng2012"/> At ultrasound, the findings of acute epididymitis include an enlarged hypoechoic or hyperechoic (presumably secondary to hemorrhage) epididymis [Fig. 20a]. Other signs of inflammation such as increased vascularity, reactive hydrocele, pyocele and scrotal wall thickening may also be present. Testicular involvement is confirmed by the presence of testicular enlargement and an inhomogeneous echotexture. Hypervascularity on colorDoppler images [Fig. 20b] is a well-established diagnostic criterion and may be the only imaging finding of epididymo-orchitis in some men.<ref name="MakTzeng2012"/> <gallery widths=220 heights=180>File:Ultrasonography of epididymitis.jpg|[[Doppler ultrasound]] of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased (7 mm).File:Ultrasonography of orchitis.jpg|Doppler ultrasound of the scrotum of the same case, in the axial plane, showing orchitis (as part of epididymo-orchitis) as a hypoechogenic and slightly heterogenic left testicular tissue (right in image), with an increased blood flow. There is also swelling of peritesticular tissue.</gallery> ====Further workup====If epididymitis is visualized, the scrotum should also be scanned for any potential abscess formation.}}
===Epididymitis and epididymo-orchitis===
[[File:Scrotal ultrasonography of epididymo-orchitis.jpg|thumb|Epididymo-orchitis in a 77 year-old man. (a) Transverse sonography shows enlargement of the epididymis with hypoechogenicity noted over the testis and epididymis associated with scrotal wall thickening. (b) Color Doppler sonography showed hyperemic change of the testis and epididymis, presenting as an “inferno” vascular flow pattern.<ref name="MakTzeng2012"/>]]
===Tuberculous epididymo-orchitis===
