Actinomyces is a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Pelvic actinomycosis is a chronic granulomatous disease caused by Actinomyces israelii that frequently mimics ovarian tumors during presentation. It is diagnosed after surgery in most of the cases. Intravenous penicillin is the most preferred therapeutic agent, and it requires hospitalization up to one month. Pelvic actinomycosis is a rare cause of ureteric obstruction and renal failure. The final diagnosis is usually difficult and often apparent only after histological examination of an operative specimen. The present case led us to consider the etiology and clinical findings and to review the management of reported cases involving ureteric obstruction.
A 58-year-old man presented with a large left scrotal swelling suspected to be a large hydrocele, both, clinically and on initial ultrasound. However, at operation, a large tunica albuginea cyst was found arising from the mid anterior wall of the tunica albuginea. It was dissected, excised and edges under run. Further review of the ultrasound scan revealed a unique feature of large tunica albuginea cyst simulating a hydrocele.
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