Identification of an abnormal lump at self-palpation is the most common way of presentation of scrotal masses. Less commonly, the patient may experience a change in the normal feeling of the testis or may experience pain, either dull or acute. Furthermore, non-palpable nodules of the testis or of other scrotal structures can be detected as an incidental finding during imaging performed for indications others than presence of a palpable mass.
US is commonly the first imaging study in these patients. It has to be stressed that an US study of the scrotum is a dynamic examination: simultaneous palpation of the scrotal content during the US study helps to correlate physical findings with the US images. This is especially useful in patients with small loose body within the vaginal cavity that may look as attached to the surface of the tunica vaginalis and may mimic a tumor.
MR imaging is not frequently needed to evaluate a scrotal mass given the high sensitivity of US in this field. There are, however, some indications in case of discrepancies between US and clinical findings, when a diffuse, non-specific change of testicular echogenicity is seen at US, when US findings are inconclusive, or when lesions containing fibrous tissue, fat or hemorrhage are suspected.
