Ultrasound imaging plays an essential role in the evaluation of palpable scrotal masses, which are a significant source of concern for both patients and physicians.

The extratesticular space is the most common site for scrotal lesions. Its complex anatomy, stemming from diverse embryological origins, gives rise to numerous potential diagnoses, contributing to diagnostic uncertainty. While most of extratesticular lesions are benign, malignancies can also arise, along with their mimics. Recognizing specific characteristic imaging features and integrating them with factors such as location, tissue origin and clinical history may lead to a definitive diagnosis.