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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 215-216

Adult penoscrotal edema as manifestation of chronic renal failure: Ultrasonographic evaluation


Department of Radiology, JNMC Medical College, DMIMS, Wardha, Maharashtra, India

Date of Submission30-Jun-2021
Date of Decision09-Nov-2021
Date of Acceptance17-Jan-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Suresh Vasant Phatak
Department of Radiology, JNMC Medical College, DMIMS, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_248_21

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How to cite this article:
Pandey S, Phatak SV, Gupta RS, Bhansali PJ, Dhawan V. Adult penoscrotal edema as manifestation of chronic renal failure: Ultrasonographic evaluation. J Datta Meghe Inst Med Sci Univ 2022;17:215-6

How to cite this URL:
Pandey S, Phatak SV, Gupta RS, Bhansali PJ, Dhawan V. Adult penoscrotal edema as manifestation of chronic renal failure: Ultrasonographic evaluation. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:215-6. Available from: http://www.journaldmims.com/text.asp?2022/17/1/215/352222



Sir,

Adult penoscrotal edema is rare in chronic renal failure. We present sonographic imaging findings in a case of chronic renal failure.

A 46-year-old diabetic male patient of chronic renal failure presented to the radiology department for scrotal sonography with a history of acute-onset painless swelling of the scrotum and penis. There is no history of any lower urinary symptoms or previous trauma to his genitalia. Physical examination showed a diffuse swelling in the penis shaft and scrotum [Figure 1]. There was no urethral discharge, and the perineal/anal examinations were unremarkable. No rashes or skin lesions were noticed on physical examination. The vital signs were within normal limits. The laboratory findings revealed deranged renal function test and hypoalbuminemia. Albumin is seen in urine microscopy.
Figure 1: Clinical photograph showing - diffuse penoscrotal swelling

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Ultrasonography (USG) was performed, which showed characteristic findings including marked thickening of the scrotal wall, with a heterogeneous striated appearance [Figure 2]. USG penis also showed gross edema around the penile tissue. The testes and epididymis demonstrated normal appearance both in grayscale and color Doppler. There was no hydrocele.
Figure 2: Ultrasonography of scrotum showing marked thickening of the scrotal wall (21.7 mm) with a characteristic heterogeneous striated appearance indicating scrotal edema. No fluid is seen around the testis

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Edema is described as an abnormal collection of fluid in the body's interstitial space. Various disorders (renal, cardiac, hepatic, gastrointestinal, endocrine, vascular, and lymphatic system diseases) may be underlying causes.[1] The scrotal wall is made up of, from superficial to the deep layers: skin, superficial fascia, dartos muscle, external spermatic fascia, cremasteric fascia, and internal spermatic fascia.[2] The normal scrotal wall thickness is approximately 2–8 mm, depending on the cremasteric muscle contraction.[3]

Scrotal edema is defined as edema of the skin and dartos fascia that does not affect the deeper layers, testes, or epididymis. It might be either unilateral or bilateral. In 50% of cases, erythema of the perineum and inguinal area is present. USG is required to confirm the diagnosis and to rule out other possible reasons for acute scrotum.[4] Marked thickening of the scrotal wall with a heterogeneous striated appearance is a typical finding.[5],[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bobkova I, Chebotareva N, Kozlovskaya L, Shilov E. Edema in renal diseases – Current view on pathogenesis. Nephrol Point Care 2016;2:pocj-5000204.  Back to cited text no. 1
    
2.
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology 2003;227:18-36.  Back to cited text no. 2
    
3.
Hricak H, Filly RA. Sonography of the scrotum. Investig Radiol 1983;18:112-21.  Back to cited text no. 3
    
4.
Grainger AJ, Hide IG, Elliott ST. The ultrasound appearances of scrotal oedema. Eur J Ultrasound 1998;8:33-7.  Back to cited text no. 4
    
5.
Herman TE, Shackelford GD, Mcalister WH. Acute idiopathic scrotal edema: Role of scrotal sonography. J Ultrasound Med 1994;13:53-5.  Back to cited text no. 5
    
6.
Breen M, Murphy K, Chow J, Kiely E, O'Regan K. Acute idiopathic scrotal edema. Case Rep Urol 2013;2013:1-3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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