Presentation
Referred to investigate a lump in the right epididymis. The patient also complained of right testicular discomfort. He had previously been affected by right-sided epididymo-orchitis but the current pain was not as severe.
Patient Data
A hypoechoic, heterogeneous intratesticular mass with irregular margins is seen in the lower pole of the right testis. Its margins appear to disrupt the tunica albuginea.
The arterial waveform within the mass is biphasic (i.e. high resistance) and abnormal. A low resistance waveform with a high PSV would be expected with focal orchitis. The arterial waveform elsewhere within the testis shows normal low resitance, continuous forward flow.
Case Discussion
An intratesticular mass was seen within the lower pole of the right testis. It had irregular margins, which appeared to cross and disrupt the tunica albuginea. At this site, the testis felt hard but elsewhere felt soft and pliable. The left testis also felt soft and pliable.
The arterial blood flow within the mass was biphasic, which is not in keeping with focal orchitis. The intratesticular flow elsewhere within the right testis was normal, low-resistance, continuous forward flow.
The overall impression was of testicular cancer (assumed until proven otherwise) rather than focal orchitis.
The patient has been booked in for an orchiectomy.