Severe scrotal pain in boys with Henoch-Schönlein purpura: incidence and sonography

Abstract

Background: Henoch-Schönlein purpura (HSP) is a systemic vasculitis with multiorgan involvement. The scrotal involvement and its sonographic appearance are less well recognized than that of the kidneys and abdomen, and the reported incidence is varied.

Objective: To review the incidence of significant scrotal involvement in boys with HSP and its sonographic characteristics.

Materials and methods: Thirteen boys (ages 4-11 years) out of 87 boys diagnosed with HSP, over a 15-year period had significant scrotal complaints. Seven underwent sonographic evaluation to define the extent of scrotal involvement and because testicular torsion was being considered.

Results: Scrotal involvement producing significant pain occurred in 15 % of boys with HSP. The majority of boys had the diagnosis of HSP established before developing scrotal complaints. Sonographic findings consistently included an enlarged, rounded epididymis, thickened scrotal skin, and a hydrocele. The testes themselves were usually sonographically normal.

Conclusions: Scrotal involvement in boys with HSP is not uncommon. The sonographic findings in the scrotum are sufficiently characteristic to allow distinction from torsion in most cases.