The patient’s case offers an extreme example of what can happen when treatment is not sought in a timely manner. A 49-year-old African American man presented with massive scrotal swelling and abdominal pain. He first noticed left inguinal swelling about 1 year earlier. This gradually progressed into the scrotum. By the time of his presentation, his scrotum extended to his knees when he was standing. His medical history included nonischemic cardiomyopathy with a left ventricular ejection fraction of 25-29% and paroxysmal atrial fibrillation.