Introduction: The introduction of contrast-enhanced ultrasound (CEUS) has been proposed as a new modality for ultrasound imaging acquisition allowing the operators and practitioners for a refinement of the tissue characterization. Methodology: The evidence in the literature on CEUS for scrotal diseases has been searched and screened in PubMed, in the span of time between 05/2004 and 05/2023. Relevant strings including mesh terms have been used. Cases of the author’s clinical practice have been included for iconographic representation of the main findings. Results: Scrotal CEUS has been shown to be a useful tool for the characterization of different clinical benign and malignant conditions, often allowing for better accuracy, sensitivity, and specificity than the conventional US parameters. Nevertheless, its use is mostly limited to centers with expertise in CEUS, and in the context of small cohort trials. Accordingly, the literature is lacking robust data to support its use in a wider and more common setting. Conclusion: Evidence in the literature suggests that scrotal CEUS is a promising imaging tool, that could be used for the characterization of doubtful scrotal or testicular lesions, and in some cases also in the follow-up of known lesions.