A 46-year-old man presented with a right scrotal swelling for over a year. Imaging including ultrasound, CT scan and Doppler ultrasound revealed a 3.0 x 2.1 cm solid and heterogeneous hypoechoic nodule in the right testis with thin tubular structures and marked hypervascularity. Pathological examination after surgery confirmed the diagnosis of a Leydig cell tumor, a rare testicular neoplasm. This case highlights the importance of ultrasound, especially Doppler ultrasound, in diagnosing Leydig cell tumors which can be difficult to distinguish from other testicular tumors based on imaging and clinical features alone.