Abstract: Objective: To explore the application of color Doppler ultrasound in the acute scrotum. Methods: The results of color Doppler ultrasound examination of 72 patients with acute scrotum were retrospectively analyzed, and compared with following-up results. Results: Of 23 cases with testicular torsion, 22 cases were diagnosed by ultrasonography, which ultrasonography displayed mainly raising testicular location, transverse or oblique, abnormal morphology, uneven hypoechoic and blood flow signal loss. Of 45 cases with epididymitis, 44 cases were diagnosed by ultrasonography, which ultrasonography displayed mainly the increasing testis and epididymis, reducting and uneven local echo. Four cases with testicular trauma were correctly diagnosed by ultrasonography, which ultrasonography displayed mainly no complete testicular morphology, partial envelope echo interrupt and uneven echo in injury area. Conclusions: Color Doppler ultrasound can reliably diagnose and differentially diagose the acute scrotum, which can provide the important application value for clinical diagnosis and treatment.