Classical case of tuberculous Epididymo-orchitis and how to rule out differentials on sonography

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Tuberculous infection of the scrotum is rare and occurs in approximately 7% of patients with tuberculosis. With the rise in the human immunodeficiency virus pandemic, the incidence of opportunistic extrapulmonary tuberculosis has correspondingly increased, the genitourinary system being the most common affected site. We present a classical case of tuberculous epididymo-orchitis with clinical, sonographic and histopathological (macro and microscopic) findings as well as the precise management plan incorporated. The sonographic imaging overlap with bacterial epididymo-orchitis, malignant testicular lesions and testicular torsion is discussed. Adequate knowledge of this entity is of utmost importance to ensure a meticulous diagnosis and treatment.