Sonographic features are consistent with a right testicular infarction (likely subacute to chronic presentation). On surgery, this was confirmed as an avascular testis, likely chronic torsion.  

MACROSCOPIC DESCRIPTION: Right testis: The tunica vaginalis is congested, hardened and thickened, with part of it received separate in the specimen pot 100 x 50 mm. The tissue surrounding the testis is yellow white firm and mostly homogenous, with a few cross-cut vessels visible. On cut section the testicular parenchyma is soft brown and friable. No focal lesions are identified.

MICROSCOPIC DESCRIPTION: Sections of testis show extensive necrosis of seminiferous tubules and tunica albuginea with an outer adherent fibroinflammatory exudate containing abundant neutrophils. Sections of epididymis show extensive fibrosis and a patchy lymphoplasmacytic chronic inflammation. No granulomas are identified. There is no evidence of vasculitis or tumor. The Gram stain highlights abundant colonies of gram-negative bacilli within testicular parenchyma. The PAS stain is negative for fungi.

DIAGNOSIS: Right testis, scrotal orchiectomy: Extensive testicular necrosis; mixed acute and chronic inflammation; colonies of gram-negative bacilli identified.