Spermatoceles are usually irregular, with low-level internal echoes while simple intratesticular cysts have uniform and smooth, thin walls and appear anechoic. In this instance, low-level echoes are present with a heart-shaped intratesticular spermatocele. The presence of bilateral tubular ectasia of the epididymal bodies and epididymal head spermatoceles further reaffirmed the intratesticular spermatocele diagnosis.