Scrotal fibrous pseudotumor is a rare tumor characterized by benign reactive fibroinflammatory tissue involving the paratesticular space, most frequently the tunica vaginalis (76%), less often the epididymis (10%), the tunica albuginea or the spermatic cord (1). Different sonographic aspects have been described, generally nonspecific and insufficient to avoid surgical exploration, required to rule out malignant processes. Case report A 28-year-old man presented at the emergency department with recent left painful scrotal swelling. No history of previous scrotal infection or trauma was noted. General physical examination and blood tests were normal (no inflammatory syndrome, C-reactive protein = 0,7 mg/dl). Scrotal examination performed by a senior urologist revealed left scrotal painful swelling with nodular palpation. Scrotal ultrasound (US) performed with a 9 MHz linear probe (Acuson S2000 TM system from Siemens Medical Solutions) showed a multinodular, mild echoic, thickening of the tunica vaginalis (1,6 mm) associated with moderate anechoic hydrocele and normal testicle (Fig. 1A). No color Doppler (CD) signal was observed within the nodules (Fig. 1B). Epididymis had a normal US aspect as the right scrotum. Contrast enhanced sonography (CEUS) of the left scrotal wall, obtained after bolus intravenous injection of 4 ml
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