We present the case of a 47-year-old man with testicular tuberculosis without epididymal involvement that simulated neoplasm on sonography. The patient also had evidence of contralateral spermatic cord involvement. The diagnosis was made following transinguinal intrascrotal exploration and excisional biopsy of the left spermatic cord mass and right transinguinal radical orchiectomy. Histopathology showed caseating granulomatous inflammation, with positive cultures for Mycobacterium tuberculosis and the patient received antituberculous treatment with satisfactory recovery.