From April 1994 to November 2004, a total of 65 patients with malignant testicular tumors underwent surgical interventions in our hospital. Clinical presentations and imaging findings led to quiet accurate preoperative diagnosis of malignant tumor, except for one case, a 29-year-old male, presenting with episodes of painful swelling in the right scrotum. All the findings including color duplex ultrasonography (US) and scintigraphy were considered as right epididymo-orchitis. Unfortunately, the patient presented with metastatic lymphadenopathy of the neck from mixed germ cell tumor of the testis 2 months later. Close follow-up for patients with suspected epididymo-orchitis is very important.