Abstract Background: Acute scrotum in neonates is a significant medical and surgical entity to deal with. It may be due to diverse causes. Aim of Study: To evaluate the radiological findings of acute scrotum in neonates and compare them with clinical and surgical data; especially as regards testicular and intestinal viability. Patients and Methods: Thirty boys (neonates) examined for acute scrotum. Clinical evaluation was done to all patients. Suitable radiological imaging was done according to the case including sonography, color Doppler and may be X-Ray. Medical or surgical management was achieved accordingly. Results: The study includes the following lesions; unilat-eral testicular torsion in 5 cases, bilateral testicular torsion in one case, complicated inguinal hernia in 12 cases, epididymitis and epididymo-orchitis in 6 cases, scrotal pyocele in 2 cases, scrotal hematoma in one case, skin infection with scrotal edema in two cases and meconium peri-orchitis with scrotal edema in one case. Sonography with color Doppler has the sensitivity, specificity and accuracy of 100%, 85% and 90% respectively as compared with surgical and clinical data. Conclusion: Acute scrotum in neonates and infants has many causes. Radiology has a major role in the differential diagnosis of these causes and correlated well with surgery. Still surgical exploration is to be considered when radiological evaluation is not conclusive.