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ORIGINAL ARTICLES |
Corresponding Author:
Mark P. Cain, MD
Riley Hospital for Children
Suite 1739
702 Barnhill Drive
Indianapolis, IN 46202
mpcain@iupui.edu
(317)274-7446
Fax: (317) 274-7481
Idiopathic scrotal edema is an uncommon cause of acute scrotal problems in children.
This is a diagnosis that can be confirmed with color Doppler ultrasound, thus obviating
the need for surgical exploration.1-4 Although the
literature documents the benefit of Doppler ultrasound in identifying blood flow
to the testis in these patients, there is little mentioned with regards to the scrotal
wall changes on ultrasound.5-7 We submit
ultrasound findings in three boys that presented to us with characteristic findings
of idiopathic scrotal edema, each of which had significant scrotal wall subcutaneous
edema on ultrasound examination.
All three patients presented with acute onset of scrotal swelling and erythema. Scrotal
ultrasound demonstrated similar findings in all three patients, including normal
appearing testicular parenchyma and excellent blood flow to both testes. There was
significant peritesticular edema with the appearance of considerable fluid in the
scrotal wall (see Figure 1 and 2), with marked thickening
of the subcutaneous tissues. There was also a significant increase in the vascularity
of the scrotal skin and subcutaneous tissues. One patient was admitted overnight
for IV antibiotics due to the severity of the scrotal wall edema. Two patients received
oral Benadryl for the presumed diagnosis of idiopathic scrotal edema. Recovery was
uncomplicated, with complete resolution of symptoms within 48 hours in all 3 patients.
The findings of significant scrotal wall edema on ultrasound examination of patients
with idiopathic scrotal edema are most likely underreported in the literature. This
is consistent with the disease process and together with findings of normal testicular
blood flow, would assist in confirming the diagnosis in patients with suspected idiopathic
scrotal edema, and permit conservative management with the avoidance of unnecessary
scrotal exploration.
Bibliography
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Melekos MD, Asbach HW, Markou SA: Etiology of acute scrotum in 100 boys with regard
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