This 62 y/o male presented with a painful, swollen right hemiscrotum and was referred for ultrasound. Selected images shown above demonstrate extratesticular sonolucency which contains low level echoes. The testis does not demonstrate any focal ultrasonic abnormality. Scrotal abscess (pyocele), hematocele, and complex hydrocele were considered in the differential diagnosis. Further findings of low grade fever and the subsequent finding of elevated WBC count and positive blood culture led to the correct diagnosis of scrotal abscess.

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