Abstract
Ultrasound (US) examination in combination with color-Doppler US is the imaging modality of choice for evaluating the scrotum. Scrotal conditions are generally divided into testicular and extratesticular disorders; the latter may affect the epididymis, the spermatic cord, the tunica vaginalis, the skin and the subcutaneous tissue. The embryology of the scrotal contents is complex and has a number of anatomical and clinical consequences. We present the case of a patient with extraosseous Ewing's sarcoma of the thigh and ipsilateral scrotal swelling caused by lymphatic edema secondary to inguinal lymph node involvement. US combined with color-Doppler allowed differentiation between lymphoma or neoplastic involvement and lymphedema or vascular edema. If the US operator is thoroughly familiar with the scrotal lymphatic and vascular system, US imaging can help identify the pathogenesis of the edema and provide the clinicians and surgeons with important information.