it is isoechoic to the testis but at times it may be cystic. The appendix epididymis is of the same size as the appendix testis but is more often pedunculated. Clinically pain may occur with torsion of either appendage. Physical examination showed a small, firm nodule is palpable on the superior aspect of the testis and a bluish discoloration known as ‘‘blue dot’’ sign may be seen on the overlying skin. Torsion of the appendiceal testis most frequently involved in boys aged 7–14 years (Dogra and Bhatt 2004). The sonographic features of testicular appendiceal torsion include a circular mass with variable echogenicity located adjacent to the testis or epididymis [Fig. 30], reactive hydrocele and skin thickening of the scrotum is common, increased peripheral vascular flow may be found around the testicular appendage on color Doppler ultrasound. Surgical intervention is unnecessary and pain usually resolves in 2 to 3 days with an atrophied or calcified appendages remaining. Hematocele A scrotal hematocele is a collection of blood in the tunica vaginalis around the testicle. It can follow trauma (such as a straddle injury) or can be a complication of surgery. It is often accompanied by testicular pain. It has been reported in patients with hemophilia and following catheterization of the femoral artery. If the diagnosis is not clinically evident, transillumination (with a penlight against the scrotum) will show a non-translucent fluid inside the scrotum. Ultrasound imaging may also be useful in confirming the diagnosis. In severe or non-resolving cases, surgical incision and drainage may be required. To prevent recurrence following surgical drainage, a drain may be left at the surgical site. Fibrotic striations A striated pattern of the testicle, radiating from its mediastinum, does not have clinical importance unless there are alarming symptoms or abnormal signal on Doppler ultrasonography. It is presumed to represent fibrosis. Conclusion Ultrasound remains as the mainstay in scrotal imaging not only because of its high accuracy, excellent depiction of scrotal anatomy, low cost and wide availability, it is also useful in determining whether a mass is intra- or extra-testicular, thus providing us useful and valuable information to decide whether a mass is benign or malignant even though malignancy does occur in extratesticular tumors and vice versa. Furthermore, ultrasound also provides information essential to reach a specific diagnosis in patients with testicular torsion, testicular appendiceal torsion and inflammation such as epididymo-orchitis, Fournier gangrene etc., thus enabling us to