Right-Sided Extra-Testicular Mass Coexisting with Right Sided Hydrocele

Context: An extra-testicular mass coexisting with a hydrocele presents a diagnostic challenge as the hydrocele may obscure clinical examination findings. This overlap can hinder detection of the mass and complicate radiological interpretation, making diagnostic imaging crucial for evaluation and management. Methods: Clinical and radiological data were obtained from the case records of a 60-year-old male presenting with right-sided scrotal swelling. The patient underwent physical examination and diagnostic imaging, including Doppler ultrasound. Imaging findings were reviewed to assess the characteristics of the mass and its effect on adjacent scrotal structures. Results: Doppler ultrasound revealed a well-defined, heterogeneous right-sided extra-testicular mass at the lower pole of the right testis, coexisting with a moderate hydrocele. The hydrocele obscured accurate palpation of the underlying lesion. The mass displaced the testis anteriorly and exerted pressure on the epididymis, but vascular flow was preserved in both testes and epididymis. No internal vascularity was detected within the lesion. Based on these findings, the patient underwent surgical excision of the mass and hydrocele repair, which provided both diagnostic clarification and definitive treatment. Conclusion: This case underscores the diagnostic difficulties posed by hydrocele in identifying coexisting extra-testicular masses. Doppler ultrasound remains indispensable in differentiating benign from malignant scrotal lesions when clinical evaluation is inconclusive. Surgical exploration not only establishes a definitive diagnosis but also serves as a therapeutic intervention. Early recognition of this diagnostic challenge can prevent delays in appropriate management.