Torsion of the testicular appendages represents the most common cause of an acute scrotum in prepubertal boys. Itssonographic appearances on gray-scale US and color Doppler US have already been presented in several studies. The aim ofthis analysis was to expand those already established techniques with strain elastography and thus present typical features ofthis entity on multiparametric US. Retrospective analysis of all patients presented to the urologicaldepartment with an acute scrotum between January 2018 and July 2020 identified eleven patients 6-17 years old (mean, 11.1years), discharged with the diagnosis torsion of the testicular appendages that were examined with a high-end ultrasound device.Results: On gray-scale US all patients showed a round lesion with heterogenous echotexture adjacent to the upper poleof the testis/epididymis with a diameter of 4 to 11.1 mm (mean, 7.7 mm). Scrotal skin thickening and a concomitant hydrocelewere found in 9 (81.8%) and 7 (63.6%) cases, respectively. On color Doppler images, all torsed appendages were avascularand in 9 (81.8%) patients we observed hyperemia of the adjacent epididymis. Strain elastography showed increased tissuestiffness in all documented images. Torsion of the testicular appendages has a set of features on multiparametricUS. Awareness of this features can facilitate diagnosis of torsion of the testicular appendages and reduce unnecessary surgicalscrotal exploration or unwarranted antibiotic treatment.