Idiopathic Scrotal Edema

Acute idiopathic scrotal edema (AISE) is a fairly common, yet underreported cause of the acute scrotum in children, accounting for as many as 30% of patients who undergo assessment (Najmaldin and Burge 1987). It is characterized by the rapid onset of nontender, frequently unilateral scrotal and penile erythema and edema. The patient is usually afebrile and is otherwise asymptomatic, apart from the distressing appearance of the genitalia. It is usually found in prepubertal children from 5 to 11 years of age. As the name implies, the cause of AISE is unknown; however, some children present with a history of asthma or allergic conditions such as eczema or dermatitis (Klin et al. 2002). Laboratory investigations are usually normal, with occasional patients demonstrating mild peripheral eosinophilia. This has led many to believe the underlying cause of AISE is atopic in origin; other possible etiologies include insect bites, scrotal trauma, and parasitic infection (Hanstead and John 1964).

Physical examination reveals an edematous, erythematous, hyperthermic scrotal wall without underlying testicular tenderness. The penile shaft skin maybe involved; however, there is no history of irritative or obstructive voiding symptoms. Lower abdominal, inguinal, and perineal involvement is also frequently encountered. Urine and blood work is usually normal, apart from the previously mentioned occasional eosinophilia. Scrotal US should be performed to rule out surgically correctible conditions such as testicular torsion, infection, or abscess formation. US consistently demonstrates thickening and increased echogenicity of the scrotal wall with increased peritesticular and scrotal blood flow (Herman et al. 1994).

AISE is a self-limiting phenomenon and therefore reassurance, scrotal support, and close observation are the mainstays of therapy. Antibiotics and anti-inflammatory medications are usually redundant; however, the use of antihistamines is a reasonable option, as an underlying allergic etiologyis likely responsible for this condition.

Other scrotal masses, which may mimic testicular torsion, include hydroceles, hernias, tumors, and lesions secondary to a patent processus vaginalis. History, physical examination, and scrotal US will usually determine the underlying etiology and dictate further management. Communicating hydroceles are common in infancy; patients typically present with an otherwise asymptomatic intermittently swollen hemiscrotum. If the child is older, the swelling may enlarge with ambulation and subsequently decrease in size upon recumbence. Physical examination will reveal a fluid filled mass, which easily transilluminates and can be reduced with gentle pressure (Fig. 8.45a, b). The underlying tes-

Fig. 8.45. a Typical appearance of a communicating hydrocele in a 1-year-oldboy. b Decompression of the hydrocele and verifying the presence of a patent processus vaginalis tis is usually normal. Treatment consists of conservative therapy, as most resolve by 12-18 months of age. Thereafter, inguinal hydrocele repair is the treatment of choice.

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