Testicular pain and swelling

31yo with R testicle pain and swelling 5/7.

Urine clear.

ED Ultrasound:

Images show:

- Enlarged, very heterogenous R testicle with increased vascularity. Small hydrocoele.

- Very suspicious for malignancy. DDx severe orchitis/ TB

Admitted urology.

Consideration for orchidectomy.

CRP<2 WCC normal. But tumour markers also normal.

Urology discussing orchidectomy vs IVAB and rescan.

Formal Ultrasound:

Orchitis causes an enlarged hypoechoic testicle which is hyper vascular. Discrete masses or a very heterogenous echo texture should print Ix for malignancy/TB/trauma