If there is a lack of development of these attachments, the testis is free to twist on its vascular pedicle. This will result in torsion of the spermatic cord and interruption of testicular blood flow. Testicular torsion occurs most commonly at 12 to 18 years but can occur at any age. Torsion results in swelling and edema of the testis, and as the edema increases, testicular perfusion is further altered. The extent of testicular ischemia depends on the degree of torsion, which ranges from 180° to 720° or greater. The testicular salvage rate depends on the degree of torsion and the duration of ischemia. A nearly 100% salvage rate exists within the first 6 hours after the onset of symptoms; a 70% rate, within 6–12 hours; and a 20% rate, within 12–24 hours. Therefore, testicular torsion is a surgical emergency and the role of ultrasound is to differentiate it from epididymitis as both disease presents with acute testicular pain clinically. There are two types of testicular torsion: extravaginal and intravaginal. Extravaginal torsion occurs exclusively in newborns. Ultrasound findings include an enlarged heterogeneous testis, ipsilateral hydrocele, thickened scrotal wall and absence of vascular flow in the testis and spermatic cord. The ultrasound findings of intravaginal torsion vary with the duration and the degree of rotation of the spermatic cord. Gray scale ultrasound may appear normal if the torsion just occurs. At 4–6 hours after onset of torsion, enlarged testis with decreased echogenicity is seen. At 24 hours after onset, the testis appears heterogeneous due to vascular congestion, hemorrhage and infarction. As gray scale ultrasound is often normal during early onset of torsion, Doppler sonography is considered essential in early diagnosis of testicular torsion. The absence of testicular flow at color and power Doppler ultrasound is considered diagnostic of ischemia, provided that the scanner is set for detection of slow flow, the sampling box is small and the scanner is adjusted for the lowest repetition frequency and the lowest possible threshold setting. Varicocele Varicocele refers to abnormal dilatation of the veins of the spermatic cord due to incompetence of valve in the spermatic vein. This results in impaired blood drainage into the spermatic vein when the patient assumes a standing position or during Valsalva's maneuver. Varicoceles are more common on the left side due to the following reasons (a) The left testicular vein is longer; (b) the left testicular vein enters the