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Pelvis » Scrotum And Testicles
Acute idiopathic scrotal edema
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Author(s) :
Taco Geertsma, MD
 
Presentation 5 year old boy with a red painful swollen scrotum
 
 
 
Caption: Longitudinal image of the scrotum
Description: There is a massively swollen scrotal wall but a normal testis
 
 
 
Caption:  Transverse image of the scrotal wall
Description: There is a markedly edematous swollen scrotal wall
 
 
 
Caption:  Color doppler image of the scrotal wall
Description: There is increased vascularity of the thickened scrotal wall
 
 
 
Caption: Color doppler image of the scrotal contents on the right side
Description: The right testis and peritesticular structures have a normal aspect and show a normal vascularity
 
 
 
Caption: Color doppler image of the scrotal contents on the left side
Description: The left testis and peritesticular structures have a normal aspect and show a normal vascularity
 
Differential Diagnosis The differential diagnosis of a painful (red) swollen scrotum in a child are
Testicular torsion
Torsion of one of the appendages
Epididymitis and orchitis
Acute idiopathic scrotal edema
Since a testicular torsion needs immediate surgery, it is important to differentiate testicular torsion from the other abnormalities that do not need surgical intervention.
 
Final Diagnosis Acute idiopathic scrotal edema
 
Discussion

Acute idiopathic scrotal edema causes acute scrotal edema and erythema in children. It is a self-limiting disease that resolves without sequela. Its main symptoms are scrotal pain, scrotal, perineal, and inguinal swelling and erythema. The laboratory findings in these patients are usually unremarkable. Most of the patients have no primary source of scrotal, perineal, or perianal infection. It occurs mostly in children under 10 years of age. Since it resolves spontaneously it is important to differentiate it from other causes of acute scrotal pain and swelling that do need surgical intervention or any other form of treatment.

Acute idiopathic scrotal edema was first reported by Qvist in 1956..

Ultrasonographic findings are marked thickening of the scrotal wall, with heterogeneous and edematous appearance. It can be unilateral or bilateral. Easy compressibility can be observed in most patients. There is increased blood flow in the scrotal wall and normal or slightly increased flow in the testis and peritesticular structures. Sometimes a  mild reactive hydrocele and enlarged inguinal lymph nodes can be found. Resolution of the symptoms occurs usually within 1 to 4 days. Recurrent episodes can be observed in incidental case.

For more cases of scrotal pathology in children see www.ultrasoundcases.info


 
Case References

Klin B, Lotan G, Efrati Y, Zlotkevich L, Strauss S.Acute idiopathic scrotal edema in children—revisited. J Pediatr Surg. 2002 Aug;37(8):1200-2.

Lee A, Park SJ, Lee HK, Hong HS, Lee BH, Kim DH. Acute idiopathic scrotal edema: ultrasonographic findings at an emergency unit. Eur Radiol. 2009 Mar 4.

Baldisserotto M. Scrotal emergencies.Pediatr Radiol. 2009 May;39(5):516-21


 
Follow Up
The symptoms disappeared spontaneously within a few days
 
 
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