A 34-year-old male presented to the emergency department with a 3-hour complaint of pain in the right lower quadrant and right testicle. He stated that his pain began suddenly while standing at work. On physical examination, he had a small, firm, unreducible bulge in his right inguinal canal and an enlarged right scrotum. The patient was placed in trendelenburg position; intravenous fentanyl, valium, and dilaudid were administered; and surgery consult was obtained. A testicular ultrasonogram (Figure) was obtained owing to continued pain in the right scrotum and inability to evaluate the testicle. After viewing the ultrasound pattern, the patient was promptly taken to the operating room 6 hours after onset of symptoms.