Testicular ultrasound has emerged as the imaging modality of choice for any patient with testicular complaints. The primary indication for testicular ultrasound is acute scrotal or testicular pain. The most common etiologies of acute scrotal pain are epididymitis, orchitis, testicular torsion, and scrotal trauma. Complications of testicular torsion include testicular infarction and testicular atrophy, both of which can be diagnosed by ultrasound. Testicular ultrasound is both the initial imaging modality of choice, as well as the preferred diagnostic method for follow up of patients with acute, recurrent, or chronic testicular/scrotal symptoms. Pitfalls in testicular ultrasound may be divided into several categories. The most critical scanning pitfall relates to a misunderstanding of the skill and knowledge required for using color Doppler imaging (CDI), power Doppler imaging (PDI), or spectral Doppler imaging (SDI). The testicular ultrasound should include transverse, and inferior pole views, both in gray scale and using CDI and SDI.