Acute Scrotal Edema

Differential considerations for acute scrotal edema include:

• Infection: Epididymitis is more common. Fournier gangrene is the most concerning.
• Torsion: Testicular torsion (more common in adolescents) or torsion of the testicular appendages (higher incidence in prepubertal patients).
• Hemorrhage: Trauma, tumor
• Acute idiopathic scrotal edema: Self-limiting acute scrotal edema and erythema that resolves without sequelae in 1 to 3 days. More often bilateral. Wall thickening and hypervascularity of the scrotal wall on transverse scans resembles a fountain (see transverse color image of both testes above).
• Systemic disease: Dependent position of scrotum favors collection of fluid.

References

• Geiger J, Epelman M, Darge K. The fountain sign: a novel color Doppler sonographic finding for the diagnosis of acute idiopathic scrotal edema. J Ultrasound Med. 2010 Aug;29(8):1233-7.
• Lee A, Park SJ, Lee HK, Hong HS, Lee BH, Kim DH. Acute idiopathic scrotal edema: ultrasonographic findings at an emergency unit. Eur Radiol. 2009 Aug;19(8):2075-80.