Hi, I wish I knew the answer her. This could be several things, a hernia, a cyst, possibly the cords being twisted causing the swelling. The pain would be associated with any of that. This guy needs to get to the doc and soon. This could be very bad and needs medical attention, he could end up losing the testicle or needing surgery. Sure, it may cost money but an emergency room MUST treat him and then he can pay as he can. My hunch is that he is scared to death about what this is (us guys are pretty upset when our equipment is affected!) Hopefully it isn't cancer. But the work that he does is only going to keep aggravating this condition. Please get him to the doc. If he's unwilling, send him here and we'll see if we can help convince him. Good luck and let us know how this turns out.