Purpose or Case Report: Pediatric scrotal ultrasound pathology can be difficult because of the similar presentation of different pathology such as scrotal torsion, epididymitis, inguinal hernia, epididymal appendix torsion, and trauma. Identifying key factors of each condition is paramount to providing a clear diagnostic picture in the setting of an atypical presentation of any pathology.

Epididymitis is an inflammatory process precipitated by bacterial or viral infections. Symptoms typically present as increasing scrotal pain with swelling of the epididymis. Depending on degree of severity imaging presentation can mimic other pathology.

A 5 year old male transferred to a pediatric facility from an area hospital to assess suspected incarcerated hernia with outside CT and ultrasound images.

Methods & Materials: Outside diagnostic imaging shows complex, hyperemic mass-like structure in the superior aspect of the right scrotal sac with surrounding edema and preserved flow to both testicles.

Outside CT exam, upon second read, shows an enlarged, edematous right epididymis and small hydrocele with overlying soft tissue thickening and stranding tissue extending from the right scrotum through the inguinal canal. Examination shows no evidence of hernia or incarceration.

Results: Additional diagnostic sonography imaging demonstrated progression of inflammatory condition within the right scrotal and inguinal area. The right epididymis presented edematous, hyperemic, and heterogenous with surrounding soft tissue edema and scrotal wall thickening. Flow to the right testical was preserved however, the inflammation affected the orientation of the right testical in the scrotal sac.

Conclusions: This case highlights the difficulty in clearly identifying pathology for acute testicular pain in a pediatric patient without known trauma.