Testicular ischemia is the most serious complication of acute pathology of the scrotum, the etiopathogenesis of which is quite diverse and still remains an urgent issue for discussion. The most well-known cause of testicular ischemia is testicular torsion. All other variants are found casually rarely (orchoepididymitis, incarcerated inguinal-scrotal hernia, thrombosis of the veins of the pampiniform plexus, etc.). This paper presents clinical observations of acute testicular ischemia of various etiologies, illustrated with echographic scans and intraoperative images. The publication is supplemented with a brief review of the literature.