As some of you know, I’m a radiologist. I’d like to show a case. Man with vasectomy many years ago, has had pain in his left epididymus for some time- which could sound like congestion. We did an MRI which showed this:
(This is an axial T1 image with fat saturation, his back is down and front is up)
What you see is increased T1 signal intensity in his symptomatic left epididymus. Just one slice is shown, but the entire left epididymus looks like this. It’s not visibly swollen compared to the painless right epi.
I’ve found one article that discussed this: https://www.ajronline.org/doi/pdf/10.2214/AJR.13.11619
The increased signal intensity indicated proteinaceous material lodged within the epididymal tubules. Meaning that the contents of his epi is thick and sludgy. Could very well be a visible sign of congestion.
I haven’t found any studies that links this MRI-finding to post vasectomy pain, unfortunately. So can’t say for sure if this really is the cause of his misery. It doesn’t seem unlikely though, that he is suffering from congestion, since this is only on his symptomatic side. The “sludgy” epididymus content isn’t appreciable in the same way on ultrasound.
This can have further implications, according to the article linked. It was a study of MRI prior to vas reversal. 90% of the men with “white” epis needed vasoepididymostomy instead of vasovasostomy.
To me this suggests though that MRI could maybe be useful for PVPS as well. If you’re having a reversal, an MRI prior could suggest if you may need a vasoepididymostomy, and so you can plan accordingly to avoid surgeons who aren’t capable of that procedure.
Has any of you had an MRI of scrotum done, with findings like this?