Unilateral Redness of Scrotum (Epididymitis/Work-up Examinations)

skro_12a_n.jpg: 12.3-year-old boy with slowly occurring, moderate 'testicular' pain. The left scrotum is enlarged, and the scrotal raphe is shifted to the right side. The skin of the left scrotal half is reddish and swollen. On palpation the left testis is not really painful. skro_12b_n.jpg: Ultrasound of the right testis and epididymis. Neither organs are enlarged, and their structure is not distorted. skro_12c_n.jpg: Ultrasound of the left testis and epididymis. Notice size, shape and structure of the head of the left epididymis in comparison to the left testis and to the right side; the former is enlarged with alteration of structure. Peritesticular accumulation of fluid. skro_12d_n.jpg: Duplex ultrasound with distinctly increased perfusion of the left head of the epididymis. skro_12a_n.jpg to skro_12d_n.jpg: The diagnosis is a left-sided epididymitis. According to the history and the clinical findings another cause of the 'testicular' pain was more probable than a torsion of the testis. Therefore, not an emergency revision was performed but an ultrasound. Epididymitis occurs in children at any age and is as frequent as torsion of the testis or of a testicular appendage. Except for the occurrence in adolescence the epididymitis in childhood differs from that of young adults and elderly people concerning the etiology. One third is caused by a urological pathology or a functional bladder voiding disorder. Therefore, besides the laboratory signs of inflammation, urine analysis including bacteriological examinations and a history of micturation are always necessary, and, depending on the results, other work-up examinations. The epididymitis is not surgical except for abscess and for uncertainty of the diagnosis.