A 76 year old man regularly self catheterizes. His left scrotum has become gradually tender and swollen. The resident is very concerned there is a large solid mass.
View 2: Colour Doppler examination of the testis.
Describe and interpret these scans
Image 1: Longitudinal view sweeping through the left hemiscrotum.
A large hydrocele with several fine loculations surrounds the testis. The testis itself has heterogeneous echotexture and a single microcalcification.
Image 2: Colour Doppler examination of the testis.
There is increased vascularity demonstrated throughout the left testis.
Orchitis with associated hydrocele
Self catheterisation can cause epidiymitis and orchitis, and orchitis can lead to hydrocele formation. A complex hydrocele with layering and debris can suggest a pyocele.
Very rarely a tension hydrocele can impair testicular vascular supply and drainage allows reperfusion. Orchitis too can rarely result in focal or generalised testicular infarction. In this case there was global increase in vascularity and non-operative management with antibiotics alone was the initial course of action. Follow up ultrasound to ensure resolution was recommended.