Focal orchitis presenting as bilateral testicular masses

A 14-year-old male presented with bilateral scrotal pain. Ultrasound with Doppler revealed multiple bilateral testicular masses that were hypoechoic and hypervascular. Tumor markers and endocrinologic work-up were normal. Bilateral inguinal exploration of the testicles was done and biopsy revealed inflammation with no evidence of malignancy. The patient's pain resolved a few weeks postoperatively. Follow-up ultrasound revealed resolution of the masses. Multiple pathologic testicular entities can present as hypoechoic areas on sonography. Thorough work-up should be performed prior to advocating orchiectomy based only on ultrasound findings.