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This edema of the scrotal wall is of unknown origin, although it is believed to
represent a form of angioneurotic edema. Other etiologies include insect bites,
allergic reactions, cellulitis, and contact dermatitis. No specific therapy for
idiopathic scrotal edema has been demonstrated to be effective. Bed rest and
scrotal elevation may help. Children spontaneously begin to improve within 48
hours, regardless of treatment. Cellulitis, allergic reactions, and contact dermatitis
should be appropriately treated. Occasionally, scrotal edema is seen secondary to
diseases that cause generalized edema and/or ascites, such as nephrosis and
cirrhosis.

Kawasaki Disease
Another vasculitis that can produce scrotal swelling and mild pain is Kawasaki
disease, which has characteristic features, including fever, adenopathy, rash,
conjunctivitis, and irritability. Although discussed in detail elsewhere (see
Chapter 101 Rheumatologic Emergencies ), it is important to note the association
of scrotal swelling with this systemic disease to avoid unnecessary surgical
explorations or delay in diagnosis of the underlying vasculitis.

Testis Tumor
Testicular or paratesticular tumors are rare in young children. However, in young
males of ages 15 to 35 years, it is the most common solid tumor and represents
20% of cancers diagnosed in males. Testicular cancer usually presents as painless,
unilateral, and firm to hard scrotal swellings discovered by the patient or
physician on physical examination. Some patients report an achy feeling, and in
rapid-growing tumors associated with hemorrhage or infarction, acute scrotal pain
may be reported. Leukemic infiltration of the testis may present bilaterally. The
mass does not transilluminate, but an associated reactive hydrocele may do so. In
children younger than 2 years of age, the tumor usually is a yolk sac carcinoma,
or teratoma, and after puberty, germinal cell tumors are seen. Evaluation involves
an initial testicular ultrasound examination usually followed by surgical
exploration and a possible radical inguinal orchiectomy.

Antenatal Torsion Testis (Newborn)
A newborn boy may present with a painless, smooth, testicular enlargement that
is usually dark in color with minimal or no edema of the scrotum. This
presentation occurs in 70% of newborn cases of torsion, represents prenatal,
extravaginal torsion, whereby the entire testis and the tunica vaginalis twist
together around the spermatic cord. The remaining cases of neonatal torsion occur
postnatally during the first month of life, before fixation occurs. Salvage of the