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Aim: To investigate the frequency of different etiologies of acute scrotal pain in males presenting to the emergency department at American University of Beirut Medical Center in Beirut, Lebanon., Materials and Methods: In all, 94 patients between the ages 18 and 40 years presenting to the emergency room at American University of Beirut Medical Center with acute scrotum were recruited. The scrotum was inspected with palpation, and Doppler Ultrasound of the testicle was performed by a radiology resident to confirm the diagnosis. The study results were then collected after the official reports were signed by a board-certified radiology attending with expertise in ultrasound., Results: Of the 94 patients presenting with acute scrotal pain, 23.4% (95% confidence interval (0.70-0.87)) had no ultrasound findings and were considered normal. On the other hand, 54.3% (95% confidence interval (0.45-0.66)) were diagnosed with varicocele, 9.6% (95% confidence interval (0.04-0.16)) were diagnosed with epididymo-orchitis, and 9.6% (95% confidence interval (0.04-0.16)) had a history of trauma to the testicle. Patients presenting with acute scrotum had a pain duration of 13.2 ± 4.5 h, with 10.6% (95% confidence interval (0.04-0.17)) having associated urinary symptoms, 18.1% (95% confidence interval (0.09-0.25)) have had sexual activity within 48 h of presentation, and 10.6% (95% confidence interval (0.04-0.17)) were pre-diagnosed with varicocele., Conclusion: Varicocele is the most common cause of acute scrotal pain in patients presenting to American University of Beirut Medical Center in Beirut. This should direct varicocele to the top of our differential when a patient with acute scrotum presents to the emergency department. Nevertheless, ruling out torsion remains the first step in the workup.