Last revised by Mostafa Elfeky on 21 Dec 2022

Scrotoliths, also known as scrotal pearls, are benign incidental extratesticular macrocalcifications within the scrotum. They frequently occupy the potential space of the tunica vaginalis or sinus of the epididymis. They are usually of no clinical significance 1,2.

The prevalence of scrotoliths has been estimated to be approximately 3% 3.

Most scrotoliths are asymptomatic.

Possible etiologies include:

  • reactive fibrous proliferation during intrascrotal inflammation microtrauma to the scrotal region, e.g. mountain bikers
  • calcified loose bodies from prior torsion of the testicular appendix

Usually shows a mobile hyperechoic extratesticular focus in the potential tunica space. If large enough, the pearl usually has posterior acoustic shadowing. It may be free floating if there is an accompanying hydrocele.

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Cases and figures

  • Case 1: a scrotal pearl with hydrocele
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  • Case 2: incidental scrotolith
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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