Ok, this was a “fun” one. Definitely not something we see every day which is why I saved it till the end of the year.

I got hernia several times, and yes, that would be a good thought but remember to use the limited history you get…. no motion… ie no peristalsis. And there is a lot of vascularity as well. So what else could give you an elongated heterogeneous hypervascular mass in the inguinal canal? It’s been going on for 3-4 weeks now. The testicle is ok, but there is a hydrocoele.

Answer: infection of the spermatic cord. aka funiculitis

After a decent amount of googling, there isn’t a very good write-up on this, beyond it being worsening of epididymitis - so cord thickening, hyperemia and often with reactive fluid/hydrocoele.

here is another case with a similar appearance: https://radiopaedia.org/cases/funiculitis