A 72-Year-old Male With Left Testicular Pain

i A72-year-old men presented to his primary care physician with a chief complaint of a painful left scrotal mass of 2 weeks’ duration. He had a medical history of noninvasive bladder cancer for which he had completed a 6-week induction course of bacille Calmette-Guerin (BCG) 5 months before his present presentation. During his treatment, other than mild dysuria, he did not recall any scrotal discomfort, fever, or chills. The urine cultures were negative; however, the patient was treated with a 2-week course of ciprofloxacin antibiotics and nonsteroidal anti-inflammatory drugs. During his urologic consultation, the left scrotum was erythrematous, and an indurated mass was palpable at the lower pole of the left testis involving the epididymis, which had not decreased in size. He denied dysuria, hematuria, fevers, chills, nausea, vomiting, weight loss, or changes in bowel movements. He denied any history of urinary tract infections or other genitourinary complaints. Recent routine blood test results, including hemoglobin, hematocrit, liver function tests, -fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase, were within normal limits. His urinalysis revealed microscopic hematuria and was otherwise unremarkable. The urine culture was negative. A testicular ultrasound scan was obtained and revealed a left 3.5 1.5 cm heterogenous, hypoechoic, lobulated mass originating from the epididymal tail, with a mass effect on the lower pole of the testis (Fig. 1). Definitive invasion into the left testis could not be excluded, and the scrotum appeared indurated, with increased echogenicity suggestive of an inflammatory reaction. The right testis and epididymis were normal in appearance. A computed tomography urogram was also obtained and revealed a mildly thickened bladder wall consistent with the known previous bladder cancer and was otherwise unremarkable.