Lymphatic filariasis is common in tropical and subtropical regions.¹ A 15-year-old boy presented with 3 months of scrotal edema. Although residence in a tropical area raises a high suspicion for lymphatic filariasis caused by Wuchereria bancrofti, which can usually be diagnosed with an antigen detection card test, this patient was evaluated for lymphatic obstruction. Imaging was performed with one millicurie (mCi) of filtered Technetium sulfur colloid (Figure 1). Four intradermal injections were given in the first and second webspaces of each foot in equal divided doses. After a brisk walk, whole body anterior and posterior images were acquired immediately and 2 hours later using a dual head variable angle Gamma camera. Images showed abnormal tracer collection in the scrotum and penis with associated unsuspected dermal backflow/stasis in the left thigh region extending just above the knee. Lymphoscintigraphy was consistent with early partial obstruction of left inguinal lymphatics. A computed tomographic scan of the abdomen (Figure 2) showed soft tissue stranding in the lower anterior abdominal wall and left inguinal region suggestive of inflammatory changes (cellulitis) with bilateral scrotal edema. Microscopic examination of the surgically removed left spermatic cord showed a filarial nematode (W. bancrofti) (Figure 3). Although both W. bancrofti and Brugia malayi exist in Kerala, B. malayi rarely produces scrotal involvement or swelling above the knee. Lymphatic filariasis may be acute or chronic by presentation. Acute lymphangitis, often recurrent, is characterized by fever, chills, and erythema. Adult worms (macrofilariae) are usually concentrated in the inguinal and scrotal lymphatics, and thus lower limb and inguinal symptoms are more common, although the upper limbs and breasts may also be affected rarely. Chronicity may manifest as limb lymphedema, hydroceles, and chyluria.