A 56-year-old white man presented to the surgical outpatient clinic with swelling of the right scrotum, which started approximately 6 months prior. Swelling was intermittent and sore. The patient noted that tumefaction was more prominent in the morning on waking, and he denied any associated fever, weight loss, or other symptoms. The patient had no significant medical story. Physical examination showed a painless but tender right scrotal tumefaction in an apparently healthy obese man. No inguinal lymphadenopathy was observed. Swelling was not reducible, the right testicle was not palpable, and the transillumination test was nondiagnostic. Laboratory evaluation demonstrated a hemoglobin level of 13.5 g/dL (to convert to grams per liter, multiply by 10.0), leukocyte or white blood cell count of 11 350/μL (to convert to ×109 per liter, multiply by 0.001), and lactate dehydrogenase level of 240 U/L (to convert to microkatal per liter, multiply by 0.0167). Unenhanced computed tomography of the abdomen and pelvis was performed (Figure 1).