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A case of an asymptomatic hypoechoic testicular mass in the setting of contralateral orchitis

Nature Clinical Practice Urology volume 6, pages 108–112 (2009)Cite this article

Abstract

Background A 28-year-old heterosexual man presented to an emergency department with a 2-day history of left testicular pain and swelling that began after he started having unprotected sex with a new partner. He also had a 1-day history of fever and chills.

Investigations Physical examination, urinalysis, complete blood count, polymerase chain reaction testing for gonorrhea and chlamydia, serial scrotal ultrasonography with color Doppler imaging, and measurement of serum tumor marker levels.

Diagnosis Left orchitis with right testicular mass suspicious for malignancy.

Management The patient received antibiotic therapy (ceftriaxone and azithromycin), which resulted in resolution of his presenting symptoms. He was discharged from hospital with plans to undergo follow-up evaluation by the urology service. He opted to delay surgical intervention; repeat ultrasonography at 4 weeks revealed signs consistent with treated left-sided orchitis and revealed near-complete resolution of the right-sided lesion. The patient's right-sided mass probably represented subclinical bacterial orchitis, which responded to antibiotic therapy.

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Figure 1: Ultrasonography at presentation.
Figure 2: Repeat ultrasonography performed 4 weeks after the patient's original presentation.
Figure 3: Repeat ultrasonography performed approximately 4 months after the patient's initial presentation.

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Acknowledgements

Both authors would like to acknowledge the contributions made by John P Gay, MD, J Thomas Jones, MD, and Elizabeth Fitzpayne, the librarian of the Massachusetts Medical Society, who provided reference articles. Dr Morris would also like to acknowledge John G Gregory, MD, and Francis J McGovern, MD, for their support and encouragement in pursuit of his urological career; and the faculty and staff of the Massachusetts General Hospital for providing his urological training.

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Authors and Affiliations

  1. REA Morris is a former Staff Urologist at Waldo County General Hospital, Belfast, ME,

    Richard EA Morris

  2. AR Guimaraes is Director of Interventional Magnetic Resonance Imaging in the Department of Radiology at the Massachusetts General Hospital, Boston, MA, USA.,

    Alexander R Guimaraes

Authors
  1. Richard EA Morris
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  2. Alexander R Guimaraes
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Correspondence to Richard EA Morris.

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The authors declare no competing financial interests.

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Morris, R., Guimaraes, A. A case of an asymptomatic hypoechoic testicular mass in the setting of contralateral orchitis. Nat Rev Urol 6, 108–112 (2009). https://doi.org/10.1038/ncpuro1291

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