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Background
Many radiologists interpret ultrasound of the scrotum to exclude testicular torsion or to evaluate for epididymo-orchitis, as well as note the presence of hydroceles and varicoceles. However, given that masses of the testicles are not as commonly encountered, including testicular malignancies, the purpose of this educational exhibit is to review common and uncommon scrotal and testicular pathologies, including intratesticular and extratesticular masses and possible pitfalls. Additionally, secondary purpose is to review management strategies when sonographic findings are indeterminate, including appropriate indications for obtaining MRI of the scrotum.

Educational Goals / Teaching Points
The goal of this educational exhibit is to introduce various common and uncommon pathologies of the testicle and scrotum and review their imaging appearances as well as possible pitfalls and diagnostic dilemmas. While it is true that almost all intratesticular solid masses are malignant and most extratesticular masses in adult patients are benign, there are certain pathologies that do not fall into these categories. Additionally, the age of the patient, laboratory markers, and other clinical factors can be used to narrow down the differential diagnoses. Benign imaging findings of the testicles, such as segmental infarct, focal hematoma, and focal orchitis, may overlap with intratesticular malignancies, so knowing the clinical picture may aid with improving diagnostic accuracy. MRI of the scrotum is not a commonly ordered examination but can be a powerful tool in certain situations, including but not limited to differentiating the location of the abnormality whether intratesticular or extratesticular, further characterization of extratesticular masses such as lipoma or fibrous pseudotumor, evaluating local extent of malignant paratesticular masses such as sarcoma, or clarifying indeterminate sonographic findings including hematoma or segmental testicular infarction.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Scrotal ultrasound is a great initial test of choice to evaluate the testicles because it is cheap, accurate, and widely available. However, scrotal MRI can provide better anatomic detail, bigger field of view, and decrease operator dependence to better characterize the abnormality in question. Key anatomic issue is to differentiate whether the abnormality is within the testicle or outside of the testicle.

Conclusion
Scrotal ultrasound is a great first-line modality in evaluating scrotal/testicular pain, especially to exclude testicular torsion or epididymo-orchitis. However, there are many intratesticular and extratesticular masses to be aware of, both benign and malignant. MRI of the scrotum is not a commonly ordered examination but can be a powerful tool in certain situations to solve diagnostic dilemmas.