POCUS can be performed at the bedside to evaluate for acute scrotal conditions, including testicular torsion and inflammatory processes such as epididymo-orchitis.
A high-frequency linear transducer is typically used to scan the scrotum in two different planes. Additionally, a coronal "buddy view"—displaying both testes side by side—can aid in comparing echogenicity and vascularity.
On B-mode imaging, both testicular torsion and inflammatory conditions may present with testicular swelling and decreased homogeneity. However, color and power Doppler imaging can help to differentiate:
Inflammatory conditions (e.g., epididymo-orchitis) typically show increased vascular flow on color and power Doppler.
Testicular torsion usually demonstrates reduced or absent flow in the affected testis. However, in cases of intermittent torsion-detorsion, vascular flow may appear preserved or even increased. In such scenarios, repeat Doppler imaging after one hour may help clarify the diagnosis.
References
Kumar K, Kumari M, Kumar V, Suman SK. Evaluation of Scrotal Pathologies by Ultrasound and Color Doppler. Cureus. 2023 Mar 27;15(3):e36776. doi: 10.7759/cureus.36776
Acuña JG, Adhikari SR. Small Parts – Testicular Ultrasound. Sonoguide. American College of Emergency Physicians. Published April 1, 2025. Accessed December 1, 2025. https://www.acep.org/sonoguide/advanced/testicular
