Background: Acute scrotum has different etiological factors. Some factors like epididymo-orchitis can be treated with medical management, but some conditions like torsion and incarcerated hernia require immediate surgical intervention to treat the patient. Ultrasound with colour Doppler is an important non-invasive tool to rule out these aetiologies for acute scrotum. Aims: • To study cases of acute scrotum with ultrasound and color Doppler and note the diagnostic appearances of various diseases. • To correlate sonographic findings with clinical follow up and post operative diagnosis. • To find out limitations of sonography and color Doppler for evaluation of acute scrotum. Settings and Design: This is a cross section type of study performed in our department of radiology. Methods and Material: Patients of acute scrotal pain referred to Department of Radiology for sonographic evaluation were taken for study from November 2015 to April 2017. Echotexture and vascularity of both the testes and epididymis were evaluated. Statistical analysis used: Data was analyzed using diagram, mean ± SD, proportions. Results: In our study of 50 patients presenting with acute scrotum, 5 cases were of torsion, 36 cases of epididymo-orchitis, 2 cases of incarcerated hernia and 7 cases of varicocele. The diagnosis was confirmed by surgical exploration or follow up on the medical line of treatment Conclusions: Ultrasound with colour Doppler is an excellent modality for diagnosis of acute scrotum.