This article discusses the role of ultrasound in the workup of patients with suspected or palpable scrotal masses. By characterizing masses as intra- or extratesticular, the differential diagnosis can be narrowed considerably. Neoplasm is the primary concern with intratesticular masses, although non-neoplastic conditions, such as hematoma and focal orchitis, may have a similar appearance. Correlation with the patient's history is essential. The sonographic presentation of extratesticular pathology, including varicocele and masses of epididymal origin, is also described.