Unusual Testicular Ultrasound Findings in a Child with Henoch-Schönlein Purpura

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by the deposition of immune complexes containing immunoglobulin A antibodies. In cases of HSP, scrotal symptoms may precede other manifestations. Gray-scale and color Doppler ultrasound (US) is the primary imaging modality used to study scrotal diseases in children. In this report, we discuss a case of HSP in a 12-year-old boy with bilateral acute scrotal pain. Unusual features were sonographically observed in the isolated affected testes. In systemic vasculitis such as HSP, the scrotal involvement is uncommon and isolated affected testes with unusual sonographic features are unique in this case. Gray-scale and color Doppler US showed bilateral scrotal enlargement with subcutaneous scrotal edema and heterogeneous echogenicity of both testes. However, they maintained their normal vascularity and normal size for the patient's age. There was no sonographic evidence of hydrocele, epididymal involvement, or torsion. A follow-up examination 10 days after the initiation of steroid therapy showed significant symptom improvement. US demonstrated that both testes had normal echogenicity and normal vascularity. Scrotal skin thickening resolved. Radiologist awareness of such sonographic findings supported by proper clinical presentation is vital to distinguish HSP from other scrotal diseases, resulting in its safe management and the avoidance of unnecessary surgical exploration.