Neonatal scrotal discoloration and swelling (Case Presentation)

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 33year-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 newborn 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 discoloration. 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 investigation, 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 haematoma. An abdominal ultrasound was performed (Fig. 1). The patient’s haematological and biochemical examinations 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 laboratory tests for urinary catecholamines (homovanillic acid and vanillylmandelic acid) were also within normal limits.