SPR Unknown #66 -- FINAL

Edward Richer, M.D.

Kiery Braithwaite, MD

Children's Healthcare of Atlanta at Egleston

Keywords

spr unknown 66


Publication Date: 20120215

History

3 month old former 26 week premature male infant, admitted to the NICU at birth for multiple bowel perforations, status post repeated abdominal surgeries and ileostomy. Scrotal ultrasound requested to rule out torsion after scrotal swelling noted on physical exam.

Findings

Grayscale ultrasound images showed amorphous, echogenic paratesticular masses in each hemiscrotum, left greater than right. Questionable minimal posterior acoustic shadowing was seen in some areas. Doppler images showed no blood flow in the echogenic masses, but did show hyperemia of the scrotal skin. Doppler images of the testicles (not submitted) showed symmetric blood flow, excluding torsion. Abdominal radiograph showed amorphous calcifications projecting over the abdomen and scrotum.

Diagnosis

Meconium Periorchitis

Discussion

Meconium periorchitis is a rare inflammatory process that results from leakage of meconium secondary to in utero or neonatal intestinal perforation. By one report, fewer than 30 cases have been described in the literature.3 Meconium may enter the scrotum via a patent process vaginalis, and incites a foreign-body giant-cell reaction that can result in scrotal inflammation and swelling. Meconium can then calcify, producing the appearance of echogenic paratesticular masses with areas of acoustic shadowing. The presence of abdominal and scrotal calcifications on plain film, and the history of intestinal perforation, can help to distinguish meconium periorchitis from other scrotal masses, such as teratoma. Scrotal calfications may resolve over time.

References

  1. Siegel, Marilyn, Pediatric Sonography, 4th Edition, 2011
  2. Kirks, Donald, Practical Pediatric Imaging, 2nd Edition, 1991
  3. Sung, Tammy, et al, Solid Extratesticular Masses in Children: Radiographic and Pathologic Correlation. AJR February 2006, vol. 186 no. 2, 483-490

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