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Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement.

Lim Y, Yi BH, Lee HK, Hong HS, Lee MH, Choi SY, Park JO - Ultrasonography (2014)

Bottom Line: We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy.On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study.Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Bucheon Hospitial, Bucheon, Korea.

ABSTRACT
Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura (HSP), but there are very few reports on penile involvement. We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow-up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass-like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

No MeSH data available.


Related in: MedlinePlus

A 5-year-old boy with symptoms of Henoch-Schonlein purpura.A. Photograph shows the swelling of the right scrotum and the penis with a purpuric rash and a reddish mass-like lesion (arrow) at the penile tip. The reddish mass-like lesion causes skin twisting at the base (arrowheads) with mild deviation of the penile axis. B. Transverse ultrasonogram shows bilateral scrotal soft tissue thickening; more severe on the right side (arrowheads). White and black asterisks indicate the right and left testicles, respectively. C-E. Longitudinal grayscale (C) and color Doppler (D, E) ultrasonograms of the right epididymis show swelling with increased vascularity at the head and body (C, D). The tail of the right epididymis (arrow) also shows swelling with increased vascularity (E). The white asterisk indicates the right testicle. F, G. Longitudinal grayscale (F) and color Doppler (G) ultrasonograms of the penis show the swelling of the penile shaft and foreskin (arrowheads), and a well-defined hypoechoic mass-like lesion measuring about 1.4 cm×1.3 cm (asterisks) without vascularity on the penile tip. Arrows indicate the glans penis. H. Follow-up longitudinal ultrasonogram of the right epididymis (arrowheads) shows no swelling. I. Follow-up longitudinal ultrasonogram of the penis shows no swelling of the penile shaft and foreskin (arrowheads). The hypoechoic masslike lesion at the penile tip has disappeared. The arrow indicates the glans penis.
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f1-usg-14042: A 5-year-old boy with symptoms of Henoch-Schonlein purpura.A. Photograph shows the swelling of the right scrotum and the penis with a purpuric rash and a reddish mass-like lesion (arrow) at the penile tip. The reddish mass-like lesion causes skin twisting at the base (arrowheads) with mild deviation of the penile axis. B. Transverse ultrasonogram shows bilateral scrotal soft tissue thickening; more severe on the right side (arrowheads). White and black asterisks indicate the right and left testicles, respectively. C-E. Longitudinal grayscale (C) and color Doppler (D, E) ultrasonograms of the right epididymis show swelling with increased vascularity at the head and body (C, D). The tail of the right epididymis (arrow) also shows swelling with increased vascularity (E). The white asterisk indicates the right testicle. F, G. Longitudinal grayscale (F) and color Doppler (G) ultrasonograms of the penis show the swelling of the penile shaft and foreskin (arrowheads), and a well-defined hypoechoic mass-like lesion measuring about 1.4 cm×1.3 cm (asterisks) without vascularity on the penile tip. Arrows indicate the glans penis. H. Follow-up longitudinal ultrasonogram of the right epididymis (arrowheads) shows no swelling. I. Follow-up longitudinal ultrasonogram of the penis shows no swelling of the penile shaft and foreskin (arrowheads). The hypoechoic masslike lesion at the penile tip has disappeared. The arrow indicates the glans penis.

Mentions: The joint and abdominal pain improved by hospital day 17. However, both sides of the scrotum became edematous and tender with a purpuric rash. The penis also showed swelling and a purpuric rash with a focal reddish mass-like lesion at the penile tip. The reddish mass-like lesion caused skin twisting at the base with mild deviation of the penile axis (Fig. 1A). The patient did not complain of pain in the penile shaft or in the reddish mass-like lesion at the penile tip. No history of trauma was reported, and no evidence of a urinary tract infection or hematuria was detected. The phallus was uncircumcised, and the patient voided without difficulty or pain and had a normal urinary stream. The patient was referred for emergency scrotal ultrasound examination. On ultrasonography, bilateral scrotal soft tissue thickening was noted. It was more severe on the right side (Fig. 1B), and the right epididymis was swollen with increased vascularity, mimicking bacterial epididymitis (Figs. 1C-E). The size, echogenicity, and vascularity of both testicles were within normal limits. The penile shaft and foreskin were also swollen (Fig. 1F), and there was a well-defined hypoechoic mass-like lesion (dimensions, ~1.4 cm×1.3 cm) without vascularity on the penile tip (Fig. 1G). This lesion was not connected with the corpus cavernosum, corpus spongiosum, or glans, and seemed to originate from the tip of the foreskin. Although the lesion did not show vascularity in a Doppler study, the patient did not complain of any pain in the penile area or voiding difficulty. Follow-up ultrasonography was recommended under the impression of HSP-related large ecchymosis or purpura with a blister on the penile tip. The edema, purpuric rash, and pain in the scrotum completely subsided as did the reddish mass-like lesion on the penile tip after 2 days of continuous treatment with oral prednisolone. The penile axis also became normal. Followup ultrasonography showed no scrotal or penile edema and no epididymal swelling (Fig. 1H), and the hypoechoic mass-like lesion on the penile tip had disappeared (Fig. 1I).


Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement.

Lim Y, Yi BH, Lee HK, Hong HS, Lee MH, Choi SY, Park JO - Ultrasonography (2014)

A 5-year-old boy with symptoms of Henoch-Schonlein purpura.A. Photograph shows the swelling of the right scrotum and the penis with a purpuric rash and a reddish mass-like lesion (arrow) at the penile tip. The reddish mass-like lesion causes skin twisting at the base (arrowheads) with mild deviation of the penile axis. B. Transverse ultrasonogram shows bilateral scrotal soft tissue thickening; more severe on the right side (arrowheads). White and black asterisks indicate the right and left testicles, respectively. C-E. Longitudinal grayscale (C) and color Doppler (D, E) ultrasonograms of the right epididymis show swelling with increased vascularity at the head and body (C, D). The tail of the right epididymis (arrow) also shows swelling with increased vascularity (E). The white asterisk indicates the right testicle. F, G. Longitudinal grayscale (F) and color Doppler (G) ultrasonograms of the penis show the swelling of the penile shaft and foreskin (arrowheads), and a well-defined hypoechoic mass-like lesion measuring about 1.4 cm×1.3 cm (asterisks) without vascularity on the penile tip. Arrows indicate the glans penis. H. Follow-up longitudinal ultrasonogram of the right epididymis (arrowheads) shows no swelling. I. Follow-up longitudinal ultrasonogram of the penis shows no swelling of the penile shaft and foreskin (arrowheads). The hypoechoic masslike lesion at the penile tip has disappeared. The arrow indicates the glans penis.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4372708&req=5

f1-usg-14042: A 5-year-old boy with symptoms of Henoch-Schonlein purpura.A. Photograph shows the swelling of the right scrotum and the penis with a purpuric rash and a reddish mass-like lesion (arrow) at the penile tip. The reddish mass-like lesion causes skin twisting at the base (arrowheads) with mild deviation of the penile axis. B. Transverse ultrasonogram shows bilateral scrotal soft tissue thickening; more severe on the right side (arrowheads). White and black asterisks indicate the right and left testicles, respectively. C-E. Longitudinal grayscale (C) and color Doppler (D, E) ultrasonograms of the right epididymis show swelling with increased vascularity at the head and body (C, D). The tail of the right epididymis (arrow) also shows swelling with increased vascularity (E). The white asterisk indicates the right testicle. F, G. Longitudinal grayscale (F) and color Doppler (G) ultrasonograms of the penis show the swelling of the penile shaft and foreskin (arrowheads), and a well-defined hypoechoic mass-like lesion measuring about 1.4 cm×1.3 cm (asterisks) without vascularity on the penile tip. Arrows indicate the glans penis. H. Follow-up longitudinal ultrasonogram of the right epididymis (arrowheads) shows no swelling. I. Follow-up longitudinal ultrasonogram of the penis shows no swelling of the penile shaft and foreskin (arrowheads). The hypoechoic masslike lesion at the penile tip has disappeared. The arrow indicates the glans penis.
Mentions: The joint and abdominal pain improved by hospital day 17. However, both sides of the scrotum became edematous and tender with a purpuric rash. The penis also showed swelling and a purpuric rash with a focal reddish mass-like lesion at the penile tip. The reddish mass-like lesion caused skin twisting at the base with mild deviation of the penile axis (Fig. 1A). The patient did not complain of pain in the penile shaft or in the reddish mass-like lesion at the penile tip. No history of trauma was reported, and no evidence of a urinary tract infection or hematuria was detected. The phallus was uncircumcised, and the patient voided without difficulty or pain and had a normal urinary stream. The patient was referred for emergency scrotal ultrasound examination. On ultrasonography, bilateral scrotal soft tissue thickening was noted. It was more severe on the right side (Fig. 1B), and the right epididymis was swollen with increased vascularity, mimicking bacterial epididymitis (Figs. 1C-E). The size, echogenicity, and vascularity of both testicles were within normal limits. The penile shaft and foreskin were also swollen (Fig. 1F), and there was a well-defined hypoechoic mass-like lesion (dimensions, ~1.4 cm×1.3 cm) without vascularity on the penile tip (Fig. 1G). This lesion was not connected with the corpus cavernosum, corpus spongiosum, or glans, and seemed to originate from the tip of the foreskin. Although the lesion did not show vascularity in a Doppler study, the patient did not complain of any pain in the penile area or voiding difficulty. Follow-up ultrasonography was recommended under the impression of HSP-related large ecchymosis or purpura with a blister on the penile tip. The edema, purpuric rash, and pain in the scrotum completely subsided as did the reddish mass-like lesion on the penile tip after 2 days of continuous treatment with oral prednisolone. The penile axis also became normal. Followup ultrasonography showed no scrotal or penile edema and no epididymal swelling (Fig. 1H), and the hypoechoic mass-like lesion on the penile tip had disappeared (Fig. 1I).

Bottom Line: We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy.On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study.Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Bucheon Hospitial, Bucheon, Korea.

ABSTRACT
Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura (HSP), but there are very few reports on penile involvement. We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow-up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass-like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

No MeSH data available.


Related in: MedlinePlus