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

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.