A 24-year-old male presents with 5 days of left scrotal pain.  Pt states that the pain started suddenly 5 days ago.  He states he was seen at another hospital where an ultrasound revealed an epididymo-orchitis.  He has been treated with antibiotics and is concerned because he is not getting better.  He notices some pain with urination but no fever, chills, penile discharge or hematuria.  His vitals signs are stable and he is afebrile.  On examination, his left testicle is enlarged, firm, and tender.  His cremasteric reflex is absent on the left.  You perform an ultrasound and note the following...

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