Presentation
OBJECTIVE: Acute idiopathic scrotal edema (AISE) is an important differential diagnosis in children presenting with an acute scrotum. [ncbi.nlm.nih.gov]
Imaging Findings An eight-year-old boy presented with a sudden onset of acute right sided scrotal swelling and erythema. He was only slightly tender but walking clearly aggravated the problems. There was no history of trauma. [eurorad.org]
METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. [pesquisa.bvsalud.org]
Entire Body System
- Gangrene
Rajan DK, Scharer KA (1998) Radiology of Fournier’s gangrene. AJR Am J Roentgenol 170:163–168 PubMed Google Scholar 12. Okizuka H, Sugimura K, Yoshizako T (1992) Fournier’s gangrene: diagnosis based on MR findings. [link.springer.com]
Fournier's gangrene of the scrotum. Infectious conditions within the scrotal wall are also classified under the acute scrotum and include cellulitis and fasciitis (gangrene). [auanet.org]
gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer) - See Also: Necrosis; - I96 - scrotum - N49.3 - noninfective - N50.89 - spermatic cord - N49.1 - noninfective - N50.89 - tunica vaginalis - N49.1 - noninfective - N50.89 - vas deferens [icdlist.com]
Fournier gangrene is the most concerning. Torsion : Testicular torsion (more common in adolescents) or torsion of the testicular appendages (higher incidence in prepubertal patients). [roentgenrayreader.blogspot.com]
- Sepsis
(causing vascular endothelial leakage) Obvious sepsis syndrome with fever, tachycardia, focal infection Painless, symmetrical edema Cultures Imaging studies as needed Soft-tissue infection (eg, cellulitis, necrotizing myofasciitis) If due to cellulitis [merckmanuals.com]
The secondary endpoints were postoperative hematoma, wound sepsis and persistent edema and hardening. [scielo.br]
When left untreated, genital gangrene will progress over hours and result in overwhelming bacterial sepsis with an associated high mortality rate. [auanet.org]
[…] arthritis (RA) 関節リウマチ rib肋骨 ricketsくる病 root[神経]根 rotation1.回旋、軸旋、2.捻転 rotator cuff[肩][回旋筋]腱板 s sacral 仙骨の、仙椎の sacrum 仙骨 salvage operationサルベージ手術、救済手術 sarcoidosisサルコイドーシス sarcoma肉腫 sciatic nerve坐骨神経 sciatica 坐骨神経痛 scintigramシンチグラム scoliosis[脊柱]側弯[症] sepsis [tokyo-med.ac.jp]
Gastrointestinal
- Acute Abdomen
Introduction The "acute scrotum" may be viewed as the urologist's equivalent to the general surgeon's "acute abdomen." [auanet.org]
Cardiovascular
- Hypertension
Page 673 - National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents: Update on the 1987 task force report on high blood pressure in children and adolescents: A working group report from the National [books.google.com]
Adverse Effect : Most adverse effects are caused by the mineralocorticoid activity and include congestive heart failure, hypertension, hypokalemia, cardiac enlargement, edema, and hypokalemic alkalosis. [pediatriconcall.com]
Other consequences of portal hypertension include dilated veins in the esophagus (varices), prominent veins on the abdomen, and an enlarged spleen. [medicinenet.com]
She is slightly hypertensive at 143/74, and on exam her lungs are clear but she has notable bilateral pitting edema up to her knees. 80. [anthesis-coaching.fr]
A male infant was delivered at 32 weeks' gestation by urgent cesarean section to prevent maternal preeclampsia following the appearance of pregnancy-induced hypertension. At Birth weight was 1700 g. [e-ijd.org]
Musculoskeletal
- Contusion
These ultrasound images suggest contusion and rutpture of the right testes with hematocele. These sonographic images were taken using a Pie scanner 100 Falco ultrasound machine, by Dr. Joe Antony, MD, India. [ultrasound-images.com]
For intratesticular hematoma (intact tunica albuginea, localized hematoma within an otherwise intact testis) or local tenderness (contusion), observation, rest, cold packs and analgesics are appropriate therapy. [auanet.org]
Traumatic injuries to the testicle include, in ascending order of severity, contusion, hematoma, rupture, and dislocation. Testicular contusions cause pain but do not alter the physical examination of the scrotum. [ahcmedia.com]
Direct blow or straddle injuries result in contusion, hematoma, fracture, or rupture. [appliedradiology.com]
Skin
- Erythema
The patient mentioned that he first noticed the erythema on the anterior surface of the right hemiscrotum, which gradually extended. [ncbi.nlm.nih.gov]
Clinical History Sudden onset of right sided scrotal swelling and erythema. Four months later the same symptoms on the left side of the scrotum. [eurorad.org]
METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. [pesquisa.bvsalud.org]
- Purpura
Henoch Schonlein purpura Painful scrotal oedema, with purpuric rash over scrotum. [emed.ie]
Henoch-Schönlein Purpura Refer to Henoch-Schönlein Purpura Rarely, HSP may present with an acute scrotum resembling torsion of the testis In this situation there is usually other features of HSP Unless the diagnosis of HSP can confidently be made, surgical [kidshealthwa.com]
The clinical differential diagnosis for AISE includes other causes of acute scrotum such as: cellulitis epididymitis testicular torsion Henoch-Schönlein purpura: in the setting of a pediatric patient with joint pain and rash 8 torsion of testicular and [radiopaedia.org]
Schönlein-Henoch purpura is a condition that may cause painful scrotal swelling in young boys along with rash, joint pain, stomach pain, and blood in the urine; its cause is unknown. [stanfordchildrens.org]
- Skin Thickening
An ultrasound was organized which showed marked bilateral scrotal skin thickening and small bilateral hydroceles ( Figure 1 ). There was marked increased color flow seen throughout the scrotal skin bilaterally ( Figure 2 ). [ncbi.nlm.nih.gov]
The affected side can be larger from the swollen testis itself, a hydrocele or skin thickening. Gray scale Ultrasound Gray scale ultrasound is helpfull, not in making the diagnosis, but in predicting the outcome. [radiologyassistant.nl]
Neurologic
- Stroke
This reflex is elicited by stroking or gently pinching the skin of the upper inner thigh while observing the scrotum. A normal response is contraction of the cremasteric muscles on the ipsilateral side with unilateral elevation of the testis. [aafp.org]
Urogenital
- Scrotal Mass
Other scrotal masses, which may mimic testicular torsion, include hydroceles, hernias, tumors, and lesions secondary to a patent processus vaginalis. [barnardhealth.us]
On review of birth records, a moderate-sized scrotal mass had been appreciated on newborn examination with no other abnormalities noted. [hawaii.edu]
Painless Scrotal Masses Inguinal Hernia. [ahcmedia.com]
Evaluation of scrotal masses. Am Fam Physician. 2014 May 1. 89(9):723-7. [Medline]. Altinkilic B, Pilatz A, Weidner W. [medscape.com]
- Edema of the Scrotum
Conclusion Acute idiopathic scrotal edema is a self-limiting condition that accounts for ≥ 10% of cases of acute scrotum in children and adolescents. acute idiopathic scrotal edema acute scrotum imaging studies scrotal redness and swelling Pediatrics, [moh-it.pure.elsevier.com]
Two weeks later, in-hospital examination revealed a persistent significant bilateral edema of the scrotum, including the glans penis, with normal testes and cord, and no involvement of other structures [Figure 1] and [Figure 2]. [e-ijd.org]
- Cesarean Section
A male infant was delivered at 32 weeks' gestation by urgent cesarean section to prevent maternal preeclampsia following the appearance of pregnancy-induced hypertension. At Birth weight was 1700 g. [e-ijd.org]
This report presents a case of unilateral prenatal testicular torsion diagnosed by ultrasonography in a newborn and highlights important differential diagnosis to scrotal swelling. [2] Case Report A term boy was delivered uncomplicated by cesarean section [jcnonweb.com]
- Anorchia
In prenatal testicular torsion, the treatment is nonemergent [1], [2], [5] and serves to prevent contralateral torsion and anorchia. [jcnonweb.com]
Workup
Withfurther workup of etiologies being negative, he wasdiagnosed with idiopathic retroperitoneal fibrosis. Issues [platform.almanhal.com]
The clinical workup constitutes a careful anamnesis including pregnancy history and objective examination combined with ultrasound scan with color Doppler of the scrotum and abdomen. [jcnonweb.com]
Acute testicular torsion in children: the role of sonography in the diagnostic workup. Eur Radiol 2006;16:2527–2532. [Article] [PubMed] 10. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. [e-ultrasonography.org]
Preoperative workup The detailed history and full physical examination of each patient were assessed. The diagnosis was confirmed by fluctuation and trans-illumination. [scielo.br]
Serum
- Hypoalbuminemia
A low level of the protein albumin in the blood (hypoalbuminemia). [medicinenet.com]
In conclusion, we reported a rare case with liver cirrhosis presenting with scrotal edema secondary to hypoalbuminemia. Additionally, recurrent scrotal edema might be an ominous sign for cirrhotic patients’ outcomes. Acknowledgements None. [amj.amegroups.com]
The edema is a consequence of the hypoalbuminemia and the kidneys retaining salt and water. Pitting edema occurs when the swollen area is pressed and remains indented. Tables. [anthesis-coaching.fr]
Lastly, scrotal edema secondary to hypoalbuminemia, portal hypertension and lymphadenopathy are also rare but significant conditions that may occur under the aegis of the acute scrotum. [auanet.org]
Microbiology
- Chlamydia
Results of urine gonorrhea and chlamydia DNA amplification tests were negative. Scrotal ultrasonography revealed edematous changes without evidence of masses or torsion. He was admitted to the hospital and was started on hydroxyzine. [consultant360.com]
[…] catheter or cystoscopy **Mumps orchitis occurs 4-6days after parotitis** Red, swollen hemiscrotum Tenderness most marked posterior-lateral testis Pyuria may be present Tenderness improved with testicular elevation Urine (ideally first pass) MCS +/- chlamydia [rch.org.au]
Adolescents with epididymoorchitis should have a meatal swab for chlamydia and gonococcus. Idiopathic scrotal oedema usually resolves spontaneously over a couple of days. [emed.ie]
Several sexually transmitted diseases, including chlamydia and gonorrhea, can cause epididymitis. When it occurs in older boys, it may be because of unprotected sexual activity. [stanfordchildrens.org]
Treatment
The patient received expectant management and treatment with an NSAID to relieve his inflammation. He was discharged from hospital and his symptoms resolved within 72 h of onset of treatment. [ncbi.nlm.nih.gov]
Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual. [books.google.com]
Acute idiopathic scrotal edema does not require treatment since clinical features resolve spontaneously in 12-72 hours. Recurrences are rare. [lirias.kuleuven.be]
In some cases, your child may not need treatment. The swelling may just be watched over time, and may go away on its own. In other cases, your child may need treatment with medicine or surgery. [urmc.rochester.edu]
Prognosis
What is the Prognosis of Acute Idiopathic Scrotal Edema? (Outcomes/Resolutions) Acute Idiopathic Scrotal Edema is a condition that resolves spontaneously on its own, within a period of 1-4 days, without treatment. It has an excellent prognosis. [dovemed.com]
Treatment and prognosis AISE is a self-limiting condition, which tends to resolve in around 3-5 days. NSAIDs and antibiotics have been used in management. [radiopaedia.org]
Given its rarity, isolated involvement of the genitalia could have a more favorable prognosis. [e-ijd.org]
More than 50% of testicular ruptures occur from a direct blow to the groin during sporting activity. 4 Testicular injuries are surgical emergencies with good prognosis if treated within 72 hours. [appliedradiology.com]
Etiology
A localized allergic phenomenon, perhaps a local form of angioneurotic edema appears to be the most likely etiologic factor. [ncbi.nlm.nih.gov]
In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler "Fountain Sign" that is highly suggestive of AISE. [semanticscholar.org]
Its etiology is still unknown. The patients are in good health and blood and urine analysis is negative. Scrotal ultrasonography reveals typical thickening of the scrotal skin and normal bloodflow to the testes. [lirias.kuleuven.be]
Epidemiology
Epidemiology of atopic dermatitis: a review. Allergy Asthma Proc 2012; 33 (03) 227-234 41 Ting TV. Diagnosis and management of cutaneous vasculitis in children. Pediatr Clin North Am 2014; 61 (02) 321-346 42 Modi S, Mohan M, Jennings A. [thieme-connect.com]
Miller, Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med, 2001. 161(1): p. 15-21. 28. Brady, M.T., Cellulitis of the penis and scrotum due to group B streptococcus. J Urol, 1987. 137(4): p. 736-7. 29. [ispub.com]
Pathophysiology
Pathophysiology of Euvolemic Hyponatremia. [anthesis-coaching.fr]
Some background knowledge is assumed regarding the normal anatomy and physiology of the genitourinary system and the pathophysiology underlying specific urologic health-related problems. [books.google.com]
Other classifications (histological, pathophysiological or lymphographic) have proved less useful. [2] In approximately 14% of cases, primary lymphedema is hereditary. [e-ijd.org]
Sandlow, Varicocele: current concepts in pathophysiology, diagnosis, and treatment. Urol Clin North Am, 2002. 29(4): p. 921-37. 10. Dreyer, G., et al., Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. [ispub.com]
Prevention
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]
The suggested strategy is to fixate the contralateral testis (orchiopexy) to prevent later torsion of the healthy testis. [jcnonweb.com]
In neonates with an acute scrotum, AISE should be considered to prevent unnecessary surgical exploration. [koreamed.org]