A solid hypoechoic testicular mass must be considered malignant until proved otherwise, even if is nonpalpable. The clinical diagnosis depends upon the appearance of the lesion and the host reaction. A careful history and a thorough physical examination are very important. Complementary studies like the measurement of serum tumor markers, including alpha-fetoprotein and human chorionic gonadotrophin, and scrotal ultrasound help to improve the clinical diagnosis. High-resolution MR imaging with surface coils may provide useful information in selected patients. For some testicular masses, however, the clinical or imaging findings do not fit the typical scenario, so the management is less straightforward. This article reviews the imaging and management of one patient with atypical testicular mass.