This 5 month old presented with a several-week history of scrotal asymmetry that had changed in the days prior to admission. On admission the right hemi-scrotum was red, swollen and tender. 

Sonographic appearances are of epididymo-orchitis with an associated septated hydrocele suggesting a subacute/chronic course. CRP was elevated. The swelling and redness subsided following a course of antibiotics.

Renal tract imaging was normal.