Scrotal abscess primarily develops as a complication of severe epididymitis and/or orchitis. Undiagnosed or neglected testicular torsion is another important diagnosis that predisposes the pediatric population to the development of scrotal abscess. The clinical presentation is centered around scrotal swelling, pain, locally increased temperature, and erythema, whereas lower abdominal pain might be present in some patients. Ultrasonography is the gold standard for evaluating scrotal pathology, coupled with a detailed clinical assessment.
Scrotal abscess is considered to be a rare phenomenon in general practice [1] [2] [3]. This inflammatory condition usually stems from complicated infections of the scrotum, such as epididymitis and orchitis (particularly the necrotized forms), which can be caused by several bacterial pathogens (Escherichia coli in younger patients; Chlamydia trachomatis and Neisseria gonorrhoeae in sexually active individuals) and mumps virus. [1] [2] [3] [4] [5]. Furthermore, secondary infections with pus formation in the scrotum have been described as a consequence of the hematogenous spread of systemic infections, neglected testicular torsion, or as a complication of acute appendicitis in rare cases [1] [2] [4]. Certain congenital malformations might predispose individuals to a scrotal abscess. For example, a patent processus vaginalis can allow a passage of pus from a pyogenic process in abdominal cavity into the scrotum [2] [3]. The clinical presentation mainly consists of localized symptoms - scrotal pain that is often severe, erythema of the scrotum, and profound tenderness accompanied by heat and swelling [2]. In some patients, lower abdominal pain, fever, and vomiting may be present [2].
The diagnostic workup of scrotal abscess starts with a detailed clinical assessment comprised of two components - a detailed patient history that covers the course and progression of symptoms and a meticulous physical examination that identifies the source of inflammation and associated complaints. If these steps are properly performed, they should be sufficient to make a presumptive diagnosis. In fact, the scrotal tenderness experienced by patients might be severe enough to impede palpation and detailed evaluation, thus inspection of the affected scrotum is frequently enough to raise solid suspicion [2].
Because the differential diagnosis may be broad (in addition to intrascrotal infections and congenital malformations, squamous cell carcinoma of the scrotum is a rare, but very important etiology of scrotal symptoms) [6], laboratory and imaging studies need to be employed. Laboratory tests can reveal leukocytosis and elevated inflammatory parameters [2]. Ultrasonography is the gold-standard for assessing scrotal pathologies and should be performed in all patients [1] [7]. Typical characteristics of scrotal abscess include fluid collection with a hypervascular margin and irregular walls [1] [5] [7]. In the case of an infection, the underlying cause should be investigated through microbiological methods.