Malignant mesothelioma (MM) of the tunica vaginalis is a rare aggressive tumor with a high predilection for metastatic spread. Because there is no preoperative diagnostic modality available, it has high recurrence and mortality rates, which emphasizes the importance of early preoperative diagnosis for proper and adequate treatment. We describe a case of MM of the tunica vaginalis in a 73-year-old man who presented with hydrocele and was preoperatively diagnosed with MM using Doppler in addition to scrotal ultrasound. He underwent early radical orchiectomy through an inguinal approach, resulting in improved survival.
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