Purpose or Case Report: There is a wide spectrum of scrotal pathology in the pediatric population ranging from the benign to those requiring emergent intervention. Ultrasound is widely available, relatively low cost, and provides superior imaging of the scrotum. In addition, ultrasound has the added benefit of no ionizing radiation. Scrotal pathology may be vascular, traumatic, embryologic, or neoplastic in origin and may arise from abnormalities inherent to the scrotum or gastrointestinal or hematological in nature. Testicular torsion is the underlying cause of acute scrotum in up to 26% of pediatric patients. It is important to differentiate acute torsion from late torsion, intermittent torsion, and torsion of the appendix testis on ultrasound. Trauma involving the scrotum can result in scrotal hematoma or testicular fracture. Infectious etiologies of scrotal pathology may include epididymitis and orchitis with or without an associated pyocele. A variety of masses may be seen in the testicle including epidermoid cyst, congenital adrenal rest, germ cell tumor, and lymphoma. Ultrasound along with pertinent clinical history can be helpful in narrowing the differential diagnosis.

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