Scrotal swelling has diverse causes, including torsion (a urological emergency), trauma, infections (e.g. epididymitis, abscess), hernias, tumors, and benign conditions like hydroceles or varicoceles. Clinical evaluation includes history (onset, pain, systemic symptoms) and physical examination (standing position, palpation, transillumination, cremasteric reflex). Testicular torsion must be ruled out urgently. Doppler ultrasound is the key investigation, especially to assess blood flow and differentiate lesion types. Immediate surgical referral is warranted in cases like torsion, strangulated hernia, or Fournier’s gangrene. Management depends on the cause and may include antibiotics, surgical repair, or observation. Prompt diagnosis is critical to preserve testicular function and fertility.