A middle aged man presented with bilateral testicular pain and swelling. There was no dysuria or fever.
Testicular microlithiasis is defined as 5 or more pinpoint hyperechoic foci in a single ultrsaound field of view. This patient demonstrates microlithiasis of both the left and right testicle. In addition the colour doppler flow is increased in both testes, most prominently on the right. There is a small hydrocoele on the left containing echogenic debris.
Microlithiasis of the testes has been associated with a number of testicular conditions, both benign and malignant, with some of the benign conditions also being associated with testicular malignancy. There is debate in the literature as to how strong the association with malignancy is and what follow up should occur for those who do not have a tumour on presentation. Current, generally accepted recommendations are for follow up ultrasound screening at regular (6-12 monthly) intervals.
Bilateral bacterial orchitis is rare, whereas up to 30% of mumps orchitis is bilateral. Mumps orchitis has become increasingly uncommon since the introduction of mumps vaccination. This patient was an overseas visitor who had never had vaccination or mumps.