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Age: 42

Sex: Male

Indication: Right testicle pain and swelling

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Case #5


Findings

  • Asymmetrically increased Doppler flow in the right testis and right epididymis
  • Circumscribed, heterogeneous, hypoechoic lesion with hyperechoic internal reflectors measuring 2.4 x 2.3 x 1.6 cm in the right testis with a hyperechoic rim and lack of internal Doppler flow
  • Small right hydrocele
  • Normal appearance of the left testis
  • Incidental small left epididymal cyst measuring up to 0.6 cm


Diagnosis

Epididymo-orchitis with testicular abscess

Sample Report

Asymmetrically increased Doppler flow in the right testis and right epididymis, consistent with epididymo-orchitis.

Circumscribed, heterogeneous, hypoechoic lesion with hyperechoic internal reflectors measuring 2.4 x 2.3 x 1.6 cm in the right testis with a hyperechoic rim and lack of internal Doppler flow, concerning for a testicular abscess. However, a necrotic testicular neoplasm, segmental testicular infarct, or granulomatous disease could have a similar imaging appearance. Recommend followup imaging after treatment to ensure expected evolution of findings and to exclude neoplasm.

Small reactive right hydrocele.


Discussion

  • When evaluating patients with epididymo-orchitis, make sure to assess for complications including testicular abscess, scrotal abscess, secondary testicular infarction, and pyocele
  • Any masslike testicular lesion needs followup imaging at a minimum to exclude neoplasm


Images

Hypoechoic lesion in the right testis with peripheral but no central Doppler flow (red arrow), which is concerning for a testicular abscess in the setting of epididymo-orchitis.

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