An atypical case of meconium periorchitis as paratesticular mass in a neonate

Abstract

Key Clinical MessageA 20‐day‐old boy was presented with left scrotal swelling, clinically diagnosed as hydrocele. Ultrasonographic findings suggested hydrocele with paratesticular mass. Intraoperatively we found paratesticular mass, separate from left testis. Specimen revealed fibroconnective tissue with mucoid degeneration and focal areas of calcification suggesting meconium periorchitis. It is important to consider meconium periorchitis as one of the etiologies, thereby avoiding unnecessary orchidectomies.

Sonography of Meconium Periorchitis in the Neonate

“…[3,5] Absent color Doppler flow within the meconium hydrocele indicates non-vascular tissue which supports the diagnosis of meconium periorchitis. [4,6] However, as in our case, some scattered color Doppler flow has been reported within the meconium hydrocele, likely from localized scrotal inflammatory response. [1,7] Once the meconium hardens overtime, it may appear as multiple hyperechoic masses adjacent to the testicle with scattered shadowing calcifications.…”

“…Both the masses and calcifications of meconium tend to resolve spontaneously without compromising the testicle. [4] Initially, the presence of meconium in the scrotum results in a soft hydrocele that can be difficult to diagnose, only later presenting as hard scrotal swelling. [3] Patients are typically diagnosed in the 1 st week/ month of life, but meconium periorchitis has been reported in children up to 5 years of age.…”

“…[3] Patients are typically diagnosed in the 1 st week/ month of life, but meconium periorchitis has been reported in children up to 5 years of age. [4] If a scrotal mass is palpated, further evaluation with imaging is performed with US which can help evaluate for benign versus potential malignant etiologies. The presence of abdominal calcifications in addition to scrotal calcifications (extratesticular) on abdominal radiography strongly suggests the possibility of meconium peritonitis in the appropriate clinical setting which commonly results following intrauterine bowel perforation.…”

“…The differential ability that sonography offers between benign extratesticular lesions and malignant testicular lesions highlights its usefulness. [4] Sonographic findings of meconium periorchitis in the newborn period typically demonstrate a mixed echogenic scrotal hydrocele with numerous internal punctate echogenic foci, some with posterior shadowing indicative of calcifications, surrounding the otherwise normalappearing testicle. [3,5] Absent color Doppler flow within the meconium hydrocele indicates non-vascular tissue which supports the diagnosis of meconium periorchitis.…”

Scrotal ulcerations in a newborn secondary to unnoticed prenatal intestinal perforation

“…Different ways of MP presentation have been described and include testicular/paratesticular masses1 4 and scrotoschisis 5. It can be treated conservatively, although in our case an urgent surgery was performed to repair the skin defects and to evacuate the calcified meconium to avoid further complications.…”