Case Report: A man aged 28 years complained of a painless nodule in the left side of the scrotum. Ultrasonography (US) showed a hypoechoic nodule measuring 20×16 mm posterior to the left testis. Inside this nodule was a heterogeneous mass appearing as a nodule within a nodule. The remainder of the examination was unremarkable and included no findings of other pathology or thickening of the scrotal wall. Cytologic findings at time of surgical excision were consistent with severe chronic epididymitis. Upon further questioning, the patient admitted to having been diagnosed with gonorrhea 1 year earlier and having terminated his medication halfway through his treatment.
Discussion: The sonographic appearance of the nodule within a nodule was an important cytopathologic finding replecting histological result from the patient's early termination of treatment for gonorrhea. Because of the uncharacteristic appearance of this inflammatory mass, the patient’s lack of pain and his initial silence regarding his medical history, we had trouble arriving at a definitive diagnosis.