Caso Clinico ARP

Case Presentation A 62-year-old male presented to the emergency department with a two-week history of right testicular pain. His medical history included hypertension and prior left inguinal herniorrhaphy. On examination, both testes were within the scrotal sac, with no signs of inflammation or palpable nodules. The only notable finding was a small right hydrocele, confirmed by ultrasound (Figure 1). The patient was discharged with analgesic medication. One month later, he returned to the emergency department with complaints of right testicular pain and marked bilateral scrotal enlargement, extending to the penile base, which had developed over the past two days. Initial investigations included a scrotal ultrasound and a pelvic computed tomography (CT) scan (Figure 2). He was referred to general surgery for further evaluation. One month later, a thoracoabdominal-pelvic CT scan and an endoscopic study were performed (Figure 3). What is your diagnosis?