Ultrasound appearance of scrotal fat necrosis in prepubertal boys

Scrotal fat necrosis is a rare cause of scrotal pain in prepubertal boys. Despite its characteristic clinical presentation, it is an under-recognized entity. Specific scrotal US imaging features of this condition have not been previously reported.

To describe the US imaging features of scrotal fat necrosis.

Between January 1999 and November 2006 we identified all boys with idiopathic scrotal fat necrosis presenting for ultrasound imaging. All the children were reviewed by the urology service during the initial presentation and assessment with clinical confirmation of the diagnosis of scrotal fat necrosis. The sonographic appearances in each child were reviewed.

Over the course of 6 years we identified ten children who had the classic clinical diagnosis of idiopathic scrotal fat necrosis. The scrotal fat was characteristically hyperechoic, with posterior shadowing. This was located inferior to the testes which were displaced superiorly. The testes and epididymi were normal in all children.

There are specific imaging features of scrotal fat necrosis that when combined with the characteristic clinical presentation can confirm the diagnosis of scrotal fat necrosis.