Acute vasitis presenting as a concerning paratesticular mass in an adolescent, a case report

Abstract

The differential diagnosis of scrotal pain and swelling in adolescent males includes testicular and appendage torsion, epididymitis, epididymo-orchitis, trauma and incarcerated hernia. Physical examination, ultrasound and urinalysis often can identify the etiology of the scrotal pain and swelling. We present a case of left scrotal pain and swelling that was initially concerning for a paratesticular mass. Repeat examination and further imaging during pre-operative assessment was consistent with left-sided vasitis. The diagnosis of vasitis is difficult with ultrasound and commonly requires CT or MRI to differentiate from incarcerated inguinal hernia. Recognition of this uncommonly reported condition may prevent unnecessary surgeries.

Keywords: Inguinal hernia; Paratesticular mass; Scrotal pain; Vasitis.

Fig. 1

A. Longitudinal US scan though the cephalic pole of the left testicle shows a normal size, although mildly hypervascular left epididymal head (dashed arrows). B Longitudinal US scan through the distal portion of the left inguinal canal shows a thickened, markedly hypervascular left spermatic cord (arrows). The intervening fat shows marked increase in echogenicity consistent with inflammatory change.

Fig. 2

Coronal (A), sagittal (B) and axial (C) contrast enhanced CT images show a thickened left spermatic cord with stranding of the intervening and surrounding fat, distally (curved arrows) more than proximally (straight arrows). No left inguinal hernia is present. Notice the normal size and appearance of the right spermatic cord (arrowheads).

Fig. 3

(Ultrasound of Inguinal Canal) – Longitudinal US scan of the left inguinal canal after near complete resolution of the previously noted inflammatory changes (arrows).