Gas confined to the right testis, tunica vaginalis, seminal vesicle, and spermatic cord without involvement of the scrotal wall or perineum is consistent with right emphysematous epididymo-orchitis rather than necrotizing infection of the soft tissues (Fournier gangrene) with testicular involvement, which would be the major differential diagnosis. Hyperemia of the left testis on ultrasound indicates non-emphysematous epididymo-orchitis. Intramural gas in the bladder is in keeping with emphysematous cystitis. 

Blood cultures were positive for Veillonella (gram negative cocci) from a presumed testicular source. The patient was not a surgical candidate and died a few days later.