Emphysematous Orchitis: Imaging Diagnosis of Intratesticular Gas in Acute Scrotum

Emphysematous orchitis is an exceptionally rare necrotizing infection characterized by gas formation within the testicular parenchyma and is most commonly encountered in patients with diabetes mellitus. We report a 58-year-old man with poorly controlled diabetes who presented with painful swelling of the left hemiscrotum following inadequately treated lower urinary tract infection. Laboratory investigations revealed leukocytosis with neutrophilic predominance, while urine culture demonstrated significant growth of Escherichia coli. Scrotal ultrasonography showed an enlarged heterogeneous left testis containing multiple hyperechoic foci associated with dirty posterior acoustic shadowing and reverberation artifacts, suggestive of intratesticular gas. Computed tomography confirmed multiple gas locules within the left testicular parenchyma. Due to extensive disease, the patient underwent orchiectomy, and histopathology confirmed acute suppurative orchitis with tissue necrosis. This case highlights the characteristic sonographic and computed tomographic findings of emphysematous orchitis and emphasizes the pivotal role of imaging in facilitating early diagnosis and timely management.