Purpose or Case Report: Scrotal and paratesticular abnormalities in the pediatric population encompass a wide spectrum of conditions, ranging from benign congenital anomalies to rare but potentially aggressive neoplastic processes. Timely and accurate identification of these entities is critical for guiding appropriate clinical management, minimizing unnecessary surgical procedures, and ensuring prompt diagnosis of serious or life-threatening conditions. This pictorial review offers a thorough and visually rich overview of both frequently encountered and uncommon testicular and paratesticular lesions in children. Common findings such as hydrocele, varicocele, inguinal hernia, and epididymal cysts are presented alongside rare and unusual entities including supernumerary testis, scrotal plexiform neurofibroma, testicular adrenal rest tumors, epididymal cystadenoma, and rhabdomyosarcoma. The various types of spermatic cord hydroceles will also be shown. For each condition, characteristic imaging features are illustrated using multiple modalities—ultrasound, MRI, and CT—highlighting key diagnostic clues that aid in differentiating these lesions from mimics with similar clinical or radiologic presentations. By emphasizing the salient imaging findings and providing practical tips for interpretation, this educational exhibit aims to enhance radiologists’ awareness of rare pediatric scrotal pathologies, improve diagnostic confidence, and ultimately contribute to better-informed treatment decisions and optimized patient outcomes.
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