neonatal scrotal discoloration and swelling (case presentation)

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QUEST FOR THE DIAGNOSIS Neonatal scrotal discoloration and swelling (Case Presentation) Anastasia Oikonomou ([email protected]) 1 , Katerina Kampouri 2 , Stefanos Gardikis 2 , Marianna Skordala 3 , Georgios Vaos 2 , Panagiotis Prassopoulos 1 1.Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece 2.Department of Pediatric Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece 3.Department of Neonatology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece Correspondence A Oikonomou, Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. Tel: +30-25510-76803 | Fax: +30-25510-30473 | Email: [email protected] Received 14 November 2011; revised 26 March 2014; accepted 4 April 2012. DOI:10.1111/j.1651-2227.2012.02701.x The Discussion and Diagnosis can be found on page 888 CASE PRESENTATION A 3300-g male was born after a 37-week gestation to a 33- year-old mother after an uneventful pregnancy. A difficult vaginal delivery with cephalic presentation was carried out with instrumental assistance. Apgar scores were 5 and 8 at 1 and 5 min, respectively. Administration of oxygen was required after birth. Forty-eight hours after birth, the new- born developed mild, nonpersistent temperature ranging from 37.2 to 37.8°C and he was noted to have a painless right hemiscrotal swelling associated with scrotal discolor- ation. Erythrocyte sedimentation rate (5 mm), C-reactive protein (0.45 mg dL) and procalcitonin (0.5 ng mL) were within normal limits and there were no clinical signs of sepsis. He was otherwise a well-fed child without jaundice nor episodes of vomiting. A scrotal ultrasound was performed for further investiga- tion, which revealed normal size, echogenicity and blood flow of both testicles and a significantly oedematous scrotum with thickened subcutaneous tissue. A right hydrocele was noted with internal echoes raising the possibility of a haema- toma. An abdominal ultrasound was performed (Fig. 1). The patient’s haematological and biochemical examina- tions were within normal limits: WBC: 12,900 K lL (Neut 62.5%, Lymph 16.4%, Eos 6.6%), Ht: 33.4%, Hb: 12.1 g dL, PLT: 272 K lL, Cre: 1 mg dL, K: 4.5 mmol L, Na: 136 mmol L, total Bil: 11.3 mg dL, SGOT: 151 U L and SGPT: 32 U L. His blood pressure was normal and labora- tory tests for urinary catecholamines (homovanillic acid and vanillylmandelic acid) were also within normal limits. Figure 2 Figure 1 Acta Pædiatrica ISSN 0803–5253 ª2012 The Author(s)/Acta Pædiatrica ª2012 Foundation Acta Pædiatrica 2012 101, p. 799 799

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QUEST FOR THE DIAGNOSIS

Neonatal scrotal discoloration and swelling (Case Presentation)

Anastasia Oikonomou ([email protected])1, Katerina Kampouri2, Stefanos Gardikis2, Marianna Skordala3,Georgios Vaos2, Panagiotis Prassopoulos1

1.Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece2.Department of Pediatric Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece3.Department of Neonatology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

CorrespondenceA Oikonomou, Department of Radiology, UniversityHospital of Alexandroupolis, Democritus Universityof Thrace, Dragana, 68100 Alexandroupolis, Greece.Tel: +30-25510-76803 |Fax: +30-25510-30473 |Email: [email protected]

Received14 November 2011; revised 26 March 2014;accepted 4 April 2012.

DOI:10.1111/j.1651-2227.2012.02701.x

The Discussion and Diagnosis can be found on page 888CASE PRESENTATIONA 3300-g male was born after a 37-week gestation to a 33-year-old mother after an uneventful pregnancy. A difficultvaginal delivery with cephalic presentation was carried outwith instrumental assistance. Apgar scores were 5 and 8 at 1and 5 min, respectively. Administration of oxygen wasrequired after birth. Forty-eight hours after birth, the new-born developed mild, nonpersistent temperature rangingfrom 37.2 to 37.8�C and he was noted to have a painlessright hemiscrotal swelling associated with scrotal discolor-ation. Erythrocyte sedimentation rate (5 mm), C-reactiveprotein (0.45 mg ⁄ dL) and procalcitonin (0.5 ng ⁄ mL) werewithin normal limits and there were no clinical signs of

sepsis. He was otherwise a well-fed child without jaundicenor episodes of vomiting.

A scrotal ultrasound was performed for further investiga-tion, which revealed normal size, echogenicity and bloodflow of both testicles and a significantly oedematous scrotumwith thickened subcutaneous tissue. A right hydrocele wasnoted with internal echoes raising the possibility of a haema-toma. An abdominal ultrasound was performed (Fig. 1).

The patient’s haematological and biochemical examina-tions were within normal limits: WBC: 12,900 K ⁄ lL (Neut62.5%, Lymph 16.4%, Eos 6.6%), Ht: 33.4%, Hb: 12.1 g ⁄ dL,PLT: 272 K ⁄ lL, Cre: 1 mg ⁄ dL, K: 4.5 mmol ⁄ L, Na:136 mmol ⁄ L, total Bil: 11.3 mg ⁄ dL, SGOT: 151 U ⁄ L andSGPT: 32 U ⁄ L. His blood pressure was normal and labora-tory tests for urinary catecholamines (homovanillic acid andvanillylmandelic acid) were also within normal limits.

Figure 2Figure 1

Acta Pædiatrica ISSN 0803–5253

ª2012 The Author(s)/Acta Pædiatrica ª2012 Foundation Acta Pædiatrica 2012 101, p. 799 799