Testicular infarction and spontaneous scrotal rupture secondary to acute epididymo-orchitis.

Epididymo-orchitis is a common cause of acute unilateral testicular pain. Both infectious or non-infectious causes have been proposed and, rarely, testicular abscess formation and even infarction can occur as a severe complication. We present here a case of acute epididymo-orchitis leading to testicular abscess formation, infarction and spontaneous rupture through the scrotal wall despite appropriate antibiotic treatments. Orchidectomy and partial scrotectomy were performed during surgical exploration for management of the non-viable testis and associated scrotal sinus. Clinical vigilance is important to prevent this complication by close clinical follow up with ultrasonography and even early surgical decompression to prevent testicular loss.

Refractory hyperparathyroidism with a T3 bony lesion-differential diagnoses.

We report a case of severe hyperparathyroidism complicated by osteitis fibrosa cystica in an 83-year-old man post-myocardial infarction. The lesions were evident on magnetic resonance imaging only. A diagnosis of parathyroid carcinoma was considered due to clinical appearance of the parathyroid intraoperatively and the presence of an invasive T3 lesion mimicking metastatic disease. Differentiating parathyroid carcinoma from the benign causes at presentation can be difficult due to overlapping clinical, biochemical, radiological and histological features. The presence of bony lesions increases the diagnostic complexity of the case and demonstrates the challenges involved in the management of this disorder.