Contrast-enhanced ultrasound (CEUS) for the characterization of intra-scrotal lesions

•Grayscale and power Doppler ultrasound serve as excellent screening modalities for the assessment of intra-scrotal pathology.•Contrast-enhanced ultrasound (CEUS) has emerged as a problem-solving tool for the evaluation of indeterminate scrotal pathology.•CEUS may be used to identify candidates for testicular-sparing surgery in the setting of suspected torsion.•Recent evidence suggests that CEUS provides superior lesion characterization relative to unenhanced ultrasound.•The preponderance of the literature indicates that CEUS is a valuable imaging modality for solving diagnostic dilemmas. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality for the characterization of hepatic and renal lesions. However, there is a paucity of data describing the use of CEUS for the evaluation of intra-scrotal pathology. In the following review, we describe the clinical utility of CEUS for the characterization and differentiation of common and uncommon intra-scrotal conditions, including testicular torsion, infection, trauma, and benign and malignant intratesticular and extratesticular neoplasms. In addition, we outline key principles of CEUS and provide case examples from our institution.