Acute scrotal pain or swelling is a common referral for ultrasound investigation in pre-pubertal, adolescent and adult males. Clinical misdiagnosis of torsion and testicular malignancy is also a frequent cause of medical litigation in the United Kingdom and across the world. This presentation will describe the causes of acute scrotal conditions and the likely findings on ultrasound examination. The role of ultrasound in the diagnosis and management of acute scrotal pain will be discussed.