 Hi everyone. I am Dr. Vijay. I am here to present a rare case support on scottal tuberculosis and its findings on ultrasound and MRI. Only few cases of scottal TB have been reported in the literature. Though the radiological appearance is very typical, it can be a challenge to differentiate scottal TB from bacterial epidermal arthritis and other testicular malignances in a long-standing case. So here we describe the characteristic findings of scottal TB on ultrasound and on MRI. So a 56-year-old male patient was referred to us with the diffuse painless enlargement of bilateral sputum. Patient had fatigue, weight loss, and on examination, we could palpate a few enlarged inguinal lymph nodes. Patient was Afebrile, and his lung parankamma was normal on both CT and radiogram. So ultrasound was performed for this patient. Performing ultrasound of scottal, we found that both the epidermal and the lymph nodes were bulky, and they showed multiple hypoechoic nodular mass, and these hypoechoic nodular mass did not show vascularity with them. But there was increased vascularity adjacent to it, and this is the right test, this is the first test, and the second is of left test. So in this left test, we can see that there was also infiltration into the adjacent scottal wall, and the testers appeared distorted, although they were not bulky, and they didn't show increased vascularity. There was also edema in the scottal wall, minimal edema in scottal wall, and there were multiple enlarged lymph nodes in the hypoechoic nodular mass. After ultrasoundography, the first differential was that these hypoechoic lesions are granular matters lesions, but because there was infiltration into the scottal wall, or a suspicion of infiltration into the scottal wall, malignancy was also suspected. So MR was performed for this patient. On MRI, in T1-mated images, we could see a few or multiple intermediate single intensity lesions in both the hypoechoic nodular mass, which corresponded to the hypoechoic nodular mass on ultrasound, and they were not seen separately from epididymus. Whereas on T2, in the right hemistrotom, the lesions showed intermediate to high signal intensity, whereas in left hemistrotom, it was more of a hypoentense nodular lesions, which were also seen on the surface of testers. And there was a small hydrosythe left hemistrotom, which appeared hypoentense on T1 and hyperintense on T2-mated images. So in the right hemistrotom, as you see here, these hyperintense areas, on histopathological correlation, we realized that these hyperintense areas, they corresponded to the necrotic changes that happen in the granulomatase lesion. So in literature, there are not many descriptions about how these granulomatase lesions in the stratum behave on diffusion-mated images. In our case, there was diffusion restriction. As you see, it was hyperintense on DW, and the corresponding areas on ADC showed low valence. Normal testers does show diffusion restriction, and that is what was seen in our case too. Because of this marked diffusion restriction, lymphoma was also considered as a differential diagnosis. But in our case, testers was not bulky, and testers as such did not show any lesions, though they were distorted. On post-contrast images, and this is the first image of T1-fadset pre-contrast action image, and T1-fadset post-contrast action image, you see that there is heterogeneous post-contrast enhancement. But there are also a few non-enhancing areas within the lesions. So these non-enhancing areas, they corresponded to the hyperintense signal on T2, and also these hypointense nodular signals on the surface of testers in the left hemisphere. So they were non-enhancing, but otherwise it showed heterogeneous enhancement. And again, on a suggested image, T1 post-contrast images, you can see that the epidermis is not seen separately from the lesion, and the polyethyl testers, they were not bulky, and also they were distorted. In the left hemisphere, you can see hypointense, I mean non-enhancing areas on the surface of the testers. And what we also saw was, there is a, there is loss of fatmate between the realm of this lesion and this caudal wall, and which exhibited heterogeneous post-contrast enhancement, which suggested that there is caudal wall involvement. Again, in the literature, there are not many examples of scottal tuberculosis, where the dynamomatous lesion also involves a scottal wall. This was seen in our case, where there was also involvement of the scottal wall. Bilateral spermatic cord were also thickened and showed enhancement. And also there were a few enlarged inguinal implants, though they were not conglomerated. So, after this, our diagnosis was of dynamomatous lesion that was tuberculosis, epidermis, orcitis. But since the patient condition was deteriorating, orcitectomy was performed. And on histopathological examination, it turned out to be dynamomatous lesion on histopath. But the patients with tuberculosis, epidermis, orcitis, they respond well to anti-tubular therapy. And literature suggests that an orcitectomy is only essential if there is abscess formation within the testers. But often the diagnosis is established after orcitectomy because of suspicion of testicular malignancy, as in other cases. The biopsy should always be performed when epidermis orcitis is the part of differential diagnosis. The differences in our case included bacterial orcitis and malignancy. But history of patient and lymphedermopathy, abscess of tenderness or increased temperature of scrotum, and failure to respond to conventional antibiotics, they also suggested tubercular orcitis or a tubercular epidermis that was also confirmed with history otherwise. So, in conclusion, the take-home point is that in patients presenting with Scottish swelling, which is not very painful, and on ultrasound when we find nodular masses on epidermis and testers, it should alert the radiologist of a possible diagnosis of tuberculosis, epidermal orcitis, and consider microbacterium tuberculosis as the cause, especially if there is no response to the conventional antibiotic treatment. So, these were my references which also included only like some of the very few cases that have been reported on scrotal tuberculosis.