Scrotal abscess with testicular involvement?

Male, 67

Scrotal abscess

Presented with left scrotal swelling and pain; scrotal skin erythematous. Patient unable to give further history, but noted previously that his left testis is smaller than the right

Left scrotal lump tender and boggy; left testis not palpable separately

Planned for ultrasound scrotum to rule out testicular involvement - reported as heterogenous left testis with no vascular flow; likely infarcted with necrosis. Planned for surgical drainage KIV orchidectomy

Intra-operatively actually noted that the left testis was atrophic and undescended and was not imaged on US. The US image of the scrotal abscess mimicked the appearance of an ischemic left testicular abscess. Post-operatively, the maldescended testis was vaguely palpable in the upper scrotum.