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Benjumea Gómez LM, Muñoz Durán AF, Muñoz-Caicedo B, Aguirre Carvajal LV, Lopera Valle JS. Acute Idiopathic Scrotal Edema, an Underrecognized Cause of Scrotal Pain in Children: A Case Report and Literature Review. Cureus 2024; 16:e57988. [PMID: 38738115 PMCID: PMC11087078 DOI: 10.7759/cureus.57988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Acute idiopathic scrotal edema is a clinical entity predominant in children under 10 years whose true incidence is unknown in our setting. Diagnosis is challenging and avoids unnecessary surgeries. We present the case of an idiopathic acute scrotal edema with ultrasound findings highly suggestive of the diagnosis, which was managed conservatively with complete signs and symptoms resolution after discharge. We aim to review the ultrasound characteristics and differential diagnosis of this disorder.
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Dell'Atti L, Fabiani A, Palagonia E, Edoardo A, Pavia MP, Scarcella S, Maurelli V, Principi E, Tiroli M, Milanese G, Servi L, Galosi AB. Unusual clinical scenarios in Urology and Andrology. ACTA ACUST UNITED AC 2021; 93:120-126. [PMID: 33754624 DOI: 10.4081/aiua.2021.1.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022]
Abstract
This collection includes some unusual cases and how they were diagnosed and treated. Case 1: A case of a patient with primary hyperthyroidism presenting with a submucosal ureteral stone after endoscopic lithotripsy was described. After multiple endoscopic treatment, the stone was successfully removed by open ureterolithotomy recovering ureteral patency and normal renal function. Case 2: A case of burned-out testicular cancer with atypical lymphatic spread (stage II A) was presented. After right orchiectomy and complete remission of tumor markers, due to atypical metastases location and uncertain histology, the patient was treated with systemic therapy based on bleomycin, etoposide and cisplatin (PEB). At re-staging after chemotherapy computed tomography showed reduction of all node metastases and an observation protocol was proposed. Case 3: A patient was readmitted to hospital after 12 days from an uneventful Robot-Assisted Radical Prostatectomy (RARP) for prostate cancer due to lower abdominal pain plus abdominal distension, nausea and constipation not responsive to medical therapy. Computed Tomography showed colon and small bowel dilatation without any evidence of anatomical or mechanical obstruction. Laparoscopic abdominal exploration confirmed bowel distension without evidence of obstructing lesions. Ogilvie's Syndrome or acute colonic pseudo-obstruction (ACPO) was diagnosed. The patient fully recovered and was discharged six days after the procedure. Case 4: A case of recurrent Acute Idiopathic Scrotal Edema (AISE) was diagnosed on clinical signs together with the decisive help of pathognomonic ultrasound findings as the "fountain sign". Case 5: Small bilateral testicular nodules were diagnosed in a 30-years old patient undergoing scrotal ultrasound in follow up of acute lymphoblastic leukemia. Ultrasound guided testis sparing surgery was performed demonstrating Leydig cell tumors.
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Affiliation(s)
- Lucio Dell'Atti
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Andrea Fabiani
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Erika Palagonia
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Agostini Edoardo
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Maria Pia Pavia
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Simone Scarcella
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Valentina Maurelli
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Emanuele Principi
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Marco Tiroli
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Giulio Milanese
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Lucilla Servi
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Andrea Benedetto Galosi
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
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[Acute Idiopathic Scrotal Edema - A Relevant Differential Diagnosis of the Acute Scrotum in Childhood and Adolescence]. KLINISCHE PADIATRIE 2020; 233:59-62. [PMID: 33202426 DOI: 10.1055/a-1289-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund Das „akute Skrotum“ ist ein häufiger kinderurologischer Notfall, der eine rasche Beurteilung zur Diagnose bzw. zum Ausschluss einer Hodentorsion erfordert. Zu den weniger bekannten Differenzialdiagnosen zählt das idiopathische Skrotalödem (AISE). In dieser Studie beschreiben wir Häufigkeit und klinisches Management des AISE in unserer Klinik.
Patienten 319 Patienten im Alter von 0 bis 17 Jahren, die zwischen 01/2013 bis 12/2017 in der kinderurologischen Klinik der KUNO-Kinderklinik St. Hedwig Regensburg mit der Diagnose „akutes Skrotum“ behandelt wurden.
Methode Retrospektive Analyse der Patientenakten.
Ergebnisse 234/319 Patienten wurden ambulant und 85/319 (27%) stationär behandelt. Bei 23/319 (7,2%) wurde ein AISE diagnostiziert. Alle Patienten mit AISE wurden ambulant behandelt, bei keinem dieser Patienten musste eine operative Exploration erfolgen. Weitere Diagnosen der ambulanten Patienten: Epididymitis (87/234; 37%), Hydatidentorsion (42/234; 18%), Hodentorsion (5/234; 2%) Hodentrauma (10/234; 4%), Hydrozele (9/234; 4%), unspezifische Hodenschmerzen (58/234; 25%). Diagnosen der stationären Patienten: Hodentorsion (58/85; 68%), Hydatidentorsion (17/85; 20%), Epididymitis (8/85; 9%), Hodentrauma (1/85; 1%), Tumor (1/85; 1%).
Diskussion Das AISE ist eine Ausschlussdiagnose mit typischem klinischem Bild. Zusammen mit dem charakteristischen Befund in der (Doppler-) Sonografie ist eine sichere Abgrenzung zu anderen Differenzialdiagnosen des akuten Skrotums möglich. Durch die korrekte Diagnosestellung können unnötige Klinikaufenthalte, Operationen und medikamentöse Behandlungen vermieden werden.
Schlussfolgerung Das AISE ist eine relevante Differentialdiagnose des akuten Skrotums, das Kinder- und Jugendärzten bekannt sein sollte.
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Tan LR, Liu Z, Leow JJ, Chong YL. Acute idiopathic scrotal edema in the adult: A case report. Urol Case Rep 2019; 28:101014. [PMID: 31832333 PMCID: PMC6889552 DOI: 10.1016/j.eucr.2019.101014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022] Open
Abstract
Acute idiopathic scrotal edema (AISE) is a self-limiting disease of uncertain etiology, more common in children. It is characterized by the rapid onset and progression of edema and erythema of the scrotal skin and dartos. Although AISE does not involve the underlying testis and paratesticular structures, on initial presentation it is challenging to differentiate from other causes of acute scrotum. It is a difficult but important diagnosis, as correct identification avoids unnecessary surgical scrotal exploration. We discuss a case of AISE in a 23-year-old patient, and highlight the clinical and sonographic features which, in retrospect, were indicative of the diagnosis.
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Affiliation(s)
| | - Zhenbang Liu
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Yew Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore
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