Azoospermia represents approximately 10% of case of male infertility. Identification of etiological aspects is very important for prognostic and therapeutic evaluation. After the testicular analysis with fine needle aspiration cytology (FNAC) we reviewed the scrotal sonograms of 639 azoospermic patients. In the group of patients with obstructive azoospermia we have found a particular sonographic appearance. This consisted in a normal aspect of the testis, the epididymis have an enlargement, development of cysts and an inhomogeneous echo pattern. However we have found this particular sonographic appearance in same patients with other kinds of azoospermia. In conclusion, scrotal sonogram is a fundamental step in the diagnostic work-up of the azoospermic patient, but it does not allow to distinguish unequivocally patients affected by obstructive azoospermia.