Testicular sonograms were performed in four patients with pathologically proven metastatic neoplasms but a normal physical examination of the scrotum. An abnormal echo texture was seen in all cases: focal hypoechoic nodule (about 1 cm) in two, diffusely hypoechoic in one, and mixed diffuse/focal abnormality in one. Correct sonographic identification of the abnormal testis facilitates surgical removal and precludes unnecessary excision of the contralateral normal testes. The authors recommended testicular sonography to be used as a routine procedure in all patients with such a clinical presentation.