This case began as an investigation using computed tomography of a gluteal tuberculous (TB) abscess. This revealed an incidental testicular lesion that was subsequently evaluated with ultrasound. Ultrasound showed a well-defined testicular lesion, ipsilateral epididymal calcification and a hydrocoele. The presence of tuberculosis at other extrapulmonary sites combined with a positive response of the testicular lesion to anti-TB treatment made it possible to establish a diagnosis of TB epidiymo-orchitis. A reduction in the size of the testicular lesion on ultrasound surveillance enabled conservative management avoiding the need for orchidectomy or biopsy.
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