Testicular torsion is often confused with epididymo-orchitis (infection of the testis), leading to delays in appropriate treatment. Both conditions can present with scrotal pain and swelling, but the urgency of their management differs significantly. Doppler ultrasonography is the preferred diagnostic tool, boasting a sensitivity of 88.9% and specificity of 98.8% for detecting torsion. It assesses blood flow, with torsion showing decreased or absent flow, while epididymo-orchitis typically shows increased flow due to inflammation. Ultrasound and MRI both can have false negatives and hence chances of missing the diagnosis is present. Hence in challenging cases like partial torsion / unavailability of radiology services, scrotal exploration (surgery) is recommended as both a diagnostic and therapeutic procedure. This approach ensures timely intervention, which is critical since testicular viability significantly diminishes beyond six hours of torsion onset. Studies emphasize that immediate surgical exploration, rather than prolonged diagnostic testing, increases the likelihood of salvaging the testicle and prevents unnecessary delays in treatment