Testicular microlithiasis is a rare urological disease of unknown ethiology characterized by a huge number of tiny calcifications or calcospherites, deriving from degenerating tubular cells, which fall into the lumen of atrophic seminiferous tubules. It is generally asymptomatic, representing an occasional finding at pathologic examinations. US shows a variable number of tiny bright echoes without acoustic shadow scattered throughout testicular parenchyma. Differential diagnosis is virtually required with no other diseases. In fact hyperechoic testicular lesions, such as fibrosis, calcified granulomas, burned out tumors and lipomas mostly appear as solitary and larger lesions. Testicular microlithiasis is generally observed in cryptorchidism, Klinefelter's syndrome, male pseudohermaphroditism, but has also been described in otherwise normal testes. Association with pulmonary alveolar microlithiasis and with central nervous system calcifications in another case have also been reported. Subinfertility, with an unclear pathogenetic mechanism, possibly related to obstruction or to histological changes of seminiferous tubules, is also described. We present the case of a 13-year-old healthy boy who underwent an US examination for an injury of the scrotal area. We found a cluster of small hyperechoic foci, mainly located at the upper pole of both testes, which appeared otherwise normal. Testicular microlithiasis is generally a non-evolutive condition. However, as testicular neoplasms have recently been discovered in association with this condition, a sonographic follow-up is strongly recommended.