1) Severe scrotal pain of sudden onset (testicular torsion, testicular infarction, testicular abscess)
2) Adolescent with severe scrotal pain (testicular torsion, radionuclide scanning of the scrotum is the most accurate method of diagnosis)
3) Delayed resolution or non-resolution of acute epididymitis for standard therapy (exclude testicular tumor, abscess formation, testicular infarction, testicular cancer, TB, fungal epididymitis)
4) Ecchymotic patch in the scrotum – Bryant’s sign – may indicate blood trickled down from the abdominal cavity via a patent process vaginalis in case of abdominal aortic aneurysm, peritonitis, strangulated inguinal hernia
5) Deep skin cellulitis with necrosis and gangrene (sloughing, foul-smelling dead tissue ) involving the scrotal skin and lower abdominal areas due to a polymicrobial infection (Fournier’s gangrene requires early surgical referral, risk factors for Fournier’s gangrene – type2DM, ethanol abuse, local trauma, perineal instrumentation, paraphimosis, extravasation of urine periurethral or through a cutaneous fistula, sexually transmitted diseases causing urethral stricture, circumcision, hernioplasty),
6) Acute scrotal pain with abdominal pain and signs (peritonitis)
7) Acute scrotal pain with renal colic like the picture in an elderly hypertensive (rupture of abdominal aortic aneurysm)
8) Scrotal pain and inguinal reducible or irreducible lump (strangulated inguinal hernia)