Acute idiopathic scrotal edema T78.4

Qvist 1956

Acute idiopathic scrotal edema is a non-febrile, possibly painful or pruritic (Braun MM et al. 2013), unilateral (33% of cases)-or bilateral (66% of cases) edematous swelling of the scrotal skin and tunica dartos (Patoulias D et al. 2018), which just reaches the perineum or groin. An accompanying erythema which is clearly hyperesthetic when stroking sharply delimits the findings from the surrounding area. Palpatorily no additional abnormalities of the scrotal content and no palpable laboratory changes can be detected. Enlarged inguinal lymph nodes are described.

The etiology is unclear; a possible allergic reaction is discussed. An atopic diathesis is usually not detectable (Santi M et al.2018). The disease has been described several times in the context of a purpura Schönlein-Henoch. Lee SH et al. described the edema in the context of an Epstein-Barr infection.

Children before puberty; in a larger review study (n=311), age ranged from 5- 8 years (Santi M et al. 2018). Less frequently in adulthood.

Using ultrasound, the isolated thickening of the skin on the affected side can be documented. Its increased perfusion can be documented by colour Doppler examination (so-called Fountain-sign). Abnormalities of the testicles and epididymis should be excluded.

Possibly eosinophilia in the blood count; otherwise the laboratory is unremarkable.

testicular torsion: characteristic clinical finding; Doppler sonographic finding

Hydatid torsion characteristic clinical findings; Doppler sonographic findings;

Epididymitis characteristic clinical findings; Doppler sonographic findings;

Hernia or hydrocele characteristic clinical finding; Doppler sonographic finding;

Bacterial infections (e.g., erysipelas, scrotal phlegmon).

If necessary, bed rest and analgesics are recommended.

The disease is self-limiting and subsides within 2-3 days even without special therapy. Recurrences are possible (about 10% of cases).

1. Baruch K et al (2002) Acute idiopathic scrotal edema in children - revisited. J Ped Surg 37: 1200-1202
2. Braun MM et al (2013) A case report of acute idiopathic scrotal edema. Mil Med 178: e890-2.
3. Lee SH et al (2016) Acute Idiopathic Scrotal Edema Caused by Epstein-Barr Virus. Pediatric Infect Dis J 35:593.
4. Patoulias D et al (2018) Fountain's Sign as a Diagnostic Key in Acute Idiopathic Scrotal Edema: Case Report and Review of the Literature. Acta Medica (Hradec Kralove) 61:37-39.
5. Qvist O (1956) Swelling of the scrotum in infants and children, and nonspecific epididymitis. A study of 158 cases. Acta Chir Scand 110:417-421
6. Santi M et al (2018) Acute Idiopathic Scrotal Edema: Systematic Literature Review. Eur J Pediatrics Surgery 28:222-226.
7. Schröder A (2017) Idiopathic scrotal edema - a differential diagnosis of the acute scrotum. Actuel Urol 48: 54-56