Doppler signs of extravaginal testicular torsion mimicked by small vessel intra-testicular vasculitis in henoch-schoenlein purpura: A case report

Henoch-Schoenlein Purpura (HSP) is one of the most common types of multi-systemic vasculitis seen in childhood with “classic triad” of purpura, arthritis, and abdominal pain. Scrotal disease including scrotal swelling, epididymitis, and orchitis are very rare complications of HSP that can mimic the symptoms and signs of testicular torsion, which is one of the major surgical emergencies in children. Radiological modalities are commonly used to diagnose possible causes of acute scrotum such as testicular torsion. Here we report an 8-year-old boy, complaining of acute pain and swelling in his left testicle. Although colour Doppler ultrasonography of his testes showed increased-size parenchymal echo in the left testicle and its epididymis, with no detectable blood flow on the same side, immediate surgical exploration indicated normal pulse in both testicles’ arteries, with no signs of torsion. Finally, the pathological specimen results were consistent with the diagnosis of HSP-related testicular involvement. In conclusion, the occurrence of small vessel intra-testicular vasculitis in Henoch-Schoenlein Purpura can mimic clinical and Doppler ultrasonic signs of extravaginal testicular torsion.