Ultrasound is the primary imaging modality for evaluating intratesticular pathology, offering high‑resolution B mode and Doppler assessment that reliably differentiates intra‑ from extra- testicular disease. Most intratesticular masses are hypoechoic and malignant; however, several benign entities may mimic neoplasia. This presentation reviews the sonographic spectrum of common benign lesions—including simple cysts, epidermoid cysts, inflammatory conditions, infarction, and traumatic injuries. Malignant tumours, including seminoma, non-seminomatous germ cell tumours, lymphoma, and leukemia, typically appear as solid hypoechoic masses with variable vascularity, heterogeneous echotexture, and possible calcifications. Understanding the distinct B mode and Doppler signatures of these lesions is essential for accurate diagnosis, guiding timely management, and avoiding unnecessary surgery. Familiarity with these patterns enhances diagnostic confidence and optimizes patient outcomes in the evaluation of scrotal disease.

Male pelvic floor ultrasound is an under-utilised but potentially valuable tool in the assessment of lower urinary tract and defecatory dysfunction. While transabdominal techniques are more commonly described, transperineal ultrasound allows dynamic evaluation of pelvic floor anatomy and function in a manner analogous to female pelvic floor assessment. Key structures that can be assessed include the levator and perineal muscles, urethra and urethral sphincters, bladder base, bulb of penis, and rectum. In this case study it is demonstrated that through dynamic manoeuvres such as contraction and Valsalva, dysfunction of the pelvic floor can be recognised. Ultrasound can also identify structural changes following surgery or in the presence of scarring, strictures, or pelvic floor denervation. While there is still more to learn in this field, this case study highlights that ultrasound can provide useful clinical information.