Epididymo-orchitis is usually caused by a lower urinary tract infection and, less commonly, results from hematogenous spread or a traumatic event. Common organisms include E.Coli, Pseudamonas, Aerobacter, Gonococcus, and Chlamydia. Mumps and syphilis are other less common etiologies of orchitis. Presenting symptoms include insidious pain increasing over 1-2 days which may be accompanied by fever, dysuria, and urethral discharge. Acute epididymo-orchitis shows increased blood flow at the epididymis and/or testis when compared to the normal side. A reactive hydrocele may be present, and thickening of the overlying skin may be observed. If the entire testicle is involved, it generally appears hypoechoic and enlarged. Marked edema may compromise flow to the involved testis and potentially result in ischemia or even infarction. The appearance of a completely infracted testicle is indistinguishable from the imaging appearance of testicular torsion, namely increased flow proximal to the site of occlusion and avascularity of the testicle. Ischemia predisposes the testicle to infection, manifest as orchitis, abscess, and/or diffuse, gangrenous epididymo-orchitis. Diastolic flow reversal in the arterial waveform of the testis is a poor prognostic sign (1,2).