This patient with acute epididymo-orchitis underwent orchiectomy because a testicular neoplasm could not be ruled out on ultrasound imaging. The patient presented with increasing swelling and tenderness in one of his testicles. The gross specimen showed a large hydrocele filled with straw colored fluid. There were dense fibrous adhesions between the layers of tunica near the lower pole. There was a 3.0 cm multilocular cystic lesion filled with creamy-yellow purulent material in the lower pole as seen in this image.The abscess was centered around the epididymis with encroachment into the lower half of the testis proper. Special stains for acid-fast bacilli and fungal organisms were negative. E. coli, Pseudomonas, Klebsiella, Staphylococcus, Streptococcus, Actinomyces, and Brucella are amongst the frequent causative agents of acute epididymo-orchitis.