A rare case of bilateral scrotal tuberculosis.

Abstract

Genitourinary tuberculosis is the most common extra-pulmonary manifestation of tuberculosis. Isolated scrotal tuberculosis involvement is, however, rare and is challenging to diagnose due to similar imaging overlap with multiple conditions.

We present a case of a middle-aged man who initially presented with painless swelling of his right scrotum, for which a scrotal ultrasound demonstrated an extra-testicular hypoechoic mass involving the epididymis. A right radical orchidectomy was performed due to concerns of malignancy; pathology demonstrated no evidence of malignancy but necrotizing granulomatous inflammation, with evidence of acid-fast bacilli on Ziehl-Neelsen(ZN) staining, in keeping with tuberculosis.

The patient was referred for anti-tuberculosis medical therapy but defaulted treatment and returned 2 years later with new painless swelling of his left scrotum. A repeat scrotal ultrasound demonstrated an enlarged left testis with multiple hypoechoic nodules. The patient was subsequently referred for direct observation of anti-tuberculosis medical therapy.

This case illustrates the ultrasonographic features of scrotal tuberculosis, and radiologists should be aware of this rare differential diagnosis of scrotal masses.