Scrotum of a 12hr Old Baby Appears Edematous

Abstract Acute idiopathic scrotal edema (AISE) is a self-limiting status that is characterized by acute scrotal swelling and erythema. AISE is a very rare cause of acute scrotum, especially in neonates. Nosotros written report a example of AISE in a 26-24-hour interval-old babe who was admitted to the outpatient clinic with swelling and erythema of the penis and scrotum for a week. His vital signs were stable, and laboratory findings were non-specific. A diagnosis of AISE was made using scrotal ultrasonography with color Doppler. His symptoms resolved within 4 days after the onset of supportive treatment, and he was discharged from the hospital. In neonates with an astute scrotum, AISE should exist considered to forestall unnecessary surgical exploration. Primal words: Edema, Scrotum, Urologic diseases Introduction The acute scrotum is defined as having an acute onset and is characterized by scrotal pain, swelling, and redness [1]. The well-nigh common causes of astute scrotum are testicular torsion and acute epididymo-orchitis. Acute idiopathic scrotal edema (AISE) is a crusade of acute scrotum, characterized by scrotal swelling and erythema [2,three]. Ultrasonography with color flow Doppler tin exclude the diagnoses of testicular torsion and astute epididymo-orchitis and tin lead to the diagnosis of AISE through the identification of the fountain sign. Previous studies have shown that AISE occurs most oftentimes in patients between the ages of 5 and 11 years, simply is rare in neonates [iv]. Since AISE is a benign, selflimiting disease without complications, it is an important differential diagnosis to avert unnecessary interventions or surgical exploration of the scrotum [5, 6]. This case describes a neonate diagnosed with AISE using colour flow Doppler ultrasound. Case report A 26-day-old baby presented to the outpatient clinic with penile and scrotal swelling and redness for a week. He was delivered at 36 weeks' gestation in our infirmary. He was born through vaginal commitment. He had a mild muscular ventricular septal defect but had no history of surgery or medication use. He had no fever or dysuria. He was 51.8 cm tall (29 percentile) and weighed 4.two kg (31 percentile). His vital signs were normal, with a temperature of 37.1℃, heart rate of 138 beats/min, and respiratory rate of 36 breaths/min. There was no irritability or lethargy. On concrete examination, he had diffuse scrotal edema and penile swelling (Fig. 1). The trans-illumination test was negative. The laboratory findings on admission were equally follows: hemoglobin level, 9.9 one thousand/dL; leukocyte count, 9,700/mm3 (neutrophils 16.9%, lymphocytes 71.9%, monocytes 8.5%, eosinophils 2%); platelet count, 294×103/mmthree; aspartate aminotransferase , 26 IU/L; alanine aminotransferase level, seven IU/L; protein, 4.5 g/dL; albumin level, 3.1 1000/dL; blood nitrate urea, 3.seven mg/dL; serum creatinine, 0.i mg/dL; erythrocyte sedimentation rate, 2 mm/hr; C-reactive poly peptide 0.12 mg/L. His urinalysis results were normal. Nosotros performed ultrasound to differentiate the causes of astute scrotum. In that location was no prove of testicular torsion or epididymitis. There were characteristic findings of AISE on ultrasonography, which showed a normal scrotum and epididymis just with the scrotal sac showing diffuse edematous swelling bilaterally. There was no ascites, lymphadenopathy, or hydrocele. Subcutaneous fatty layers revealed increased vasculature on color Doppler ultrasound, with a fountain sign appearance (Fig. ii). The diagnosis of AISE was fabricated and the patient was managed conservatively with scrotal meridian. Four days later on, his symptoms improved markedly, and he was discharged from the hospital. One month later, his scrotal and penile swelling disappeared. Discussion AISE is i of the many causes of an acute scrotum, with symptoms such as scrotal edema and hurting. In astute scrotum, 46% of cases are due to testicular torsion or torsion of the appendage, and 35% are due to astute epididymo-orchitis [vii]. AISE has a prevalence of most 12–20% [ii]. AISE is a pediatric disease normally seen in children younger than 10 years of age, occurring most commonly between the ages of 5 and 8 years. Of the children diagnosed with AISE, 9% are under 2 years of age, and the disease is very rare in neonates [eight,ix]. Here, we showed a case of AISE in a 26-solar day-old newborn with swelling and erythema of the penis and scrotum for a week. Although AISE was start described by Qvist in 1956 [3], the etiology is still unclear. Allergic reactions are currently the nigh likely suspected crusade. It is known that 40% of patients have associated asthma, eczema, and dermatitis, and eosinophilia is present in 20% of cases [10]. In improver, scrotal trauma, insect bites, urine loss to the scrotal area, and cellulitis may be causative factors. Scrotal redness and swelling are the most mutual clinical signs of AISE, and scrotal pain and tenderness, scrotal, penile, perineal, and inguinal area swelling are often coexistent [8]. Of the patients who are symptomatic, the majority have unilateral involvement, while bilateral involvement is seen in 1/3 of cases. In our case, the patient had edema and redness in the scrotal and inguinal areas bilaterally. However, other symptoms were not visible and whatever specific cause could not exist found. The characteristic features of AISE are sudden onset and rapid progression, with or without the presence of fever. Laboratory studies are usually normal. Color menstruation Doppler ultrasound is the most important tool for diagnosing AISE. The specific ultrasound findings for AISE are edematous scrotal wall thickening, hyperemia of the scrotum, and normal appearance of the testicles. The feature color flow Doppler ultrasound findings include scrotal wall thickening and increased vascularity in the subcutaneous area with the appearance of h2o pouring from a fountain. Geiger first reported on the "fountain sign," which is highly suggestive of AISE [four]. The fountain sign results from the markedly increased hypervascularity of the scrotal wall, which receives its claret supply from the branches of the deep external pudendal and internal pudendal arteries through the sacral arteries [iv]. In a systemic review of AISE, the fountain sign showing hypervascularity was observed in 57 patients who underwent color Doppler ultrasonography [9]. We besides observed the fountain appearance using color Doppler ultrasonography in our case. As the fountain sign is a characteristic feature of AISE, nosotros made a diagnosis of AISE, although it is very unusual in neonates. Ultrasonography can be used to differentiate between AISE, testicular torsion, epididymitis, and testicular trauma in an astute scrotum. In testicular torsion, there is hypovascularity of the affected testis. With epididymitis, at that place is increased vascularity with increasing size of the epididymis. Testicular trauma may nowadays with intratesticular hematoma or laceration of the tunica albuginea. While testicular torsion should be treated surgically [2] and epididymitis should be treated with antibiotics, AISE is a benign, self-limiting status. Unnecessary surgery or handling can be prevented through an accurate diagnosis [11]. The treatment of AISE involves pain control and conservative management with scrotal acme. Symptoms ordinarily resolve within 2–4 days without complications [vii]. Astute scrotal discoloration with pain upon palpation in neonates is usually acquired by testicular torsion. A rare case of acute scrotum in a newborn caused by renal vein thrombosis has been shown on the first 24-hour interval of life [12]. In our case, a 26-day-old baby was presented with sudden scrotal and penile swelling without any other cause. Ultrasonography was performed to differentiate acute scrotum from other diseases. Ultrasonography showed no features of testicular torsion or epididymitis, but a fountain sign was institute. Considering the fountain sign is a characteristic feature of AISE, we fabricated a diagnosis of AISE. With merely conservative management, there was improvement of symptoms. In conclusion, AISE is an uncommon crusade of astute scrotum but important to recognize since it is a self-limiting condition. Here nosotros report a case of AISE in a 26-day-sometime neonate who presented with acute scrotal and penile swelling. Although AISE is very rare in neonates, clinicians should consider AISE in a newborn with astute scrotum and perform colour period Doppler ultrasonography to distinguish information technology from other atmospheric condition. Notes Reference 1. Gatti JM, Murphy JP. Current management of the acute scrotum. Semin Pediatr Surg 2007;16:58-63. 2. Breen M, Murphy K, Grub J, Kiely East, O'Regan K. Acute idiopathic scrotal edema. Example Rep Urol 2013;2013:one-3. 3. Qvist O. Swelling of the scrotum in infants and children, and nonspecific epididymitis; a study of 158 cases. Acta Chir Scand 1956;110:417-21. iv. Geiger J, Epelman Thousand, Darge Yard. The Fountain Sign. J Ultrasound Med 2010;29:1233-seven. v. Gordhan CG, Sadeghi-Nejad H. Scrotal hurting: Evaluation and management. Korean J Urol 2015;56:3-11. vi. Lee A, Park SJ, Lee HK, Hong HS, Lee BH, Kim DH. Astute idiopathic scrotal edema: ultrasonographic findings at an emergency unit. Eur Radiol 2009;19:2075-fourscore. seven. Al-Salem AH. Acute Scrotum. An Illustrated Guide to Pediatric Urology. 1st ed. Springer, 2017:601-17. 8. Corazza Chiliad, Pizzigoni South, Sprocati M, Virgili A. Acute idiopathic scrotal edema in children. Dermatology 2003;206:343-4. ix. Santi M, Lava SA, Simonetti GD, Bianchetti MG, Milani GP. Acute idiopathic scrotal edema: systematic literature review. Eur J Pediatr Surg 2017;15:1-5. 10. Klin B, Lotan K, Efrati Y, Zlotkevich L, Strauss South. Acute idiopathic scrotal edema in children revisited. J Pediatr Surg 2002;37:1200-2. 11. Thomas Air conditioning, Cain MP, Casale AJ, Rink RC. Ultrasound findings of acute idiopathic scrotal edema. Sci Globe J 2004;four:9-x. 12. Maas C, Müller-Hansen I, Flechsig H, Poets C. Astute scrotum in a neonate caused by renal vein thrombosis. Arch Dis Child Fetal Neonatal Ed 2011;96:F149-F50. Fig. 1. Photograph of the patient'south scrotum showing bilateral swelling and erythema. Fig. 2. Scrotal color Doppler ultrasound showing subcutaneous fat layers revealing increased vas- culature, with fountain appearance. Testicle and epididymis exercise not show whatsoever abnormal findings.

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