Isolated acute epididymitis is uncommon. It is usually seen in association with orchitis. The infection may reach epididymis in a retrograde fashion from the bladder or via hematogenous route. In acute epididymitis, the patient presents with painful enlargement of the epididymis. Right side is affected more commonly. Grossly, the epididymis is hyperemic and edematous and shows creamy fibrinopurulent exudate in the tubules. Microabscesses may be present (as seen in the top half of this image). The inflammatory process may destroy the tubular architecture.