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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.
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