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Age: 75

Sex: Male

Indication: Left scrotal swelling

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Case #23


Findings

  • Large complex left hydrocele measuring at least 10 x 6 cm
  • The left testis is mildly compressed by the large hydrocele with an otherwise unremarkable appearance of the testes and epididymides


Diagnosis

Scrotal pyocele

Sample Report

Large complex left hydrocele measuring at least 10 x 6 cm, concerning for a pyocele. Recommend urology consultation.

The left testis is mildly compressed by the large hydrocele with an otherwise unremarkable appearance of the testes and epididymides.


Discussion

  • Scrotal pyoceles are rare and typically occur as complications of epididymo-orchitis
  • If you see a hydrocele with loculations and echogenic material, think about a complex collection like a hematocele or pyocele
  • While pyoceles are often managed medically, they may require surgical management if refractory to treatment or if complicated by scrotal abscess or Fournier gangrene



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