Epididymitis is a common and morbid condition seen across a wide age range. There are multiple etiologies that may lead to inflammation of the epididymis, including infection, trauma, autoimmune disease, and vasculitis. Although there have been multiple advances in imaging of the scrotum and detection of urinary pathogens, a large portion of cases remain idiopathic. Management of epididymitis is often difficult, but relies on clinical expertise and the use of established clinical guidelines.