This 18 y/o male presented to the ER with right scrotal pain. A selected transverse image from his scrotal US is shown above. An adequate doppler evaluation could not be performed. A nuclear testicular scan was performed. Selected images shown above demonstrate ultrasonic findings of testicular microlithiasis. There is decreased flow to the right hemiscrotum on scintigraphy compatible with torsion. Findings were confirmed at surgery.