A 26-year-old man presents to the Accident and Emergency Unit with groin pain that has
come on over the past few hours, which is severe in intensity and leaves him unable to walk.
He denies dysuria, haematuria or penile discharge. There is no history of trauma.
On examination, he has a fever of 38.3 °C, with severe tenderness on palpation of the left
testis, which is also warm and swollen. A firm, tender mass is noted at the posterior aspect of
the testes. The cremasteric reflex is present. There is no change in pain noticed with elevation
of scrotum. Urine dipstick showed leukocytes. Radionucleotide scan shows increased blood
flow to the left testicle.

What is the most likely diagnosis?

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