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

Background. Henoch-Schonlein purpura (HSP) is a systemic vasculitis with mu ltiorgan involvement, The scrotal involvement and its sonographic appearanc e are less well recognized than that of the kidneys and abdomen, and the re ported incidence is varied. Objective. To review the incidence of significant scrotal involvement in bo ys with HSP and its sonographic characteristics. Materials and methods. Thirteen boys (ages 4-11 years) out of 87 boys diagn osed with HSP, over a 15-year period had significant scrotal complaints. Se ven underwent sonographic evaluation to define the extent of scrotal involv ement 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 b efore developing scrotal complaints. Sonographic findings consistently incl uded an enlarged, rounded epididymis, thickened scrotal skin, and a hydroce le, The testes themselves were usually sonographically normal. Conclusions. Scrotal involvement in boys with HSP is not uncommon. The sono graphic findings in the scrotum are sufficiently characteristic to allow di stinction from torsion in most cases.