Objective To investigate the imaging characteristics of male infertility caused by abnormal epididymis by transscrotal ultrasound. Method 82 cases of male infertility with clinically confirmed abnormal epididymis (case group) were examined by scrotal ultrasound, including 7 cases of congenital epididymal lesions and 125 cases of epididymal acquired inflammation. Result Of the 82 patients, 50 were bilateral epididymis. A total of 132 epididymis were compared with the head, body, tail thickness and health control group. The differences were statistically significant(P<0.05), 132 epididymis with fine reticular changes of 120 compared with the health control group, the difference is statistically significant(χ_²= 212.193, P<0.05). Conclusion Both congenital lesions and acquired inflammation of epididymis have obvious sonographic features, and transscrotal ultrasound can provide reliable imaging evidence for male infertility caused by epididymis.