Assessing tissue vascularisation is fundamental in characterising scrotal abnormalities. Colour Doppler ultrasound (CDUS) is commonly used to evaluate focal lesions [1-4]; However, its limitations—such as insufficient sensitivity in low-flow states—can lead to diagnostic challenges and potential misdiagnoses [5]. The first systematic study of contrast enhanced ultrasound for scrotal evaluation was reported in 2009 [6]. A key strength of CEUS lies in its ability to conclusively differentiate vascularised from non-vascularised components of scrotal contents. The technique’s capability to depict vascularity at the capillary level, combined with its use of a purely intravascular contrast agent that does not leak into the extravascular space, improves the assessment of lesion vascularity [7].

The use of CEUS in scrotal imaging has been incorporated into clinical practice [8] following guidelines such as those from the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [9], which recommend its use in specific scenarios. These include:

(i) detailing the presence or absence of vascularity in focal testicular tumours,

(ii) ascertaining viable tissue in trauma,

(iii) detailing the extent of a segmental infarction and

(iv) ascertaining the configuration and site of an abscess.