Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis

Helena Gabriel*, Nancy A. Hammond, Rocio A. Marquez, Camila Lopes Vendrami, Jeanne M. Horowitz, David D. Casalino, Paul Nikolaidis, Frank H. Miller, Shweta Bhatt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is pos-sible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratestic-ular space—although this is less common than in the testicles—and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful.

Original languageEnglish (US)
Article numbere220113
Issue number4
StatePublished - Apr 2023

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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