OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal.METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases.RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery.CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.