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The scrotal wall may be involved in a variety of pathologic processes. Such lesions may rise primarily from the layers of the scrotum or may be due to a process arising from scrotal content. Imaging is not needed in most cases, but it may be useful for making such differentiations and for evaluation of possible involvement of the testes and epididymides in cases of primary wall abnormalities. This pictorial essay will show the imaging findings observed in a variety of pathologic conditions affecting the scrotal wall, both common and unusual ones, with an emphasis on clinically relevant findings and features that lead to a specific diagnosis.

Background. A 15-year-old boy presented to hospital with tenderness in his left loin and hypochondrium, and frank hematuria; he was hemodynamically stable. The patient was overweight and had fallen onto his left flank from his bicycle 2 h previously.Investigations. Physical examination, routine blood tests, contrast-enhanced CT of the abdomen and pelvis, renal MRI and percutaneous transfemoral angiography.Diagnosis. Grade V blunt renal trauma, grade IV splenic injury and left renal vein thrombosis.Management. The patient received conservative management with supportive measures followed by percutaneous transfemoral angiography and embolization of the injured left kidney. He recovered well and was able to resume normal activities.