Figure 3.

Scrotal involvement in Henoch–Schönlein syndrome. (a) Schematic representation of the normal scrotal anatomy: scrotal wall (1), tunica vaginalis (2), testicle (3), epididymis (4), pampiniform plexus (5), spermatic artery (6). (b) Scrotal skin inflammation: bilateral thickening and swelling of the scrotal wall, small bilateral hydroceles, normal testes. (c) Orchitis: increased testicular volume and blood flow, often thickening of the scrotal wall, hydrocele, and funiculitis. (d) Epididymitis: increased epididymal volume and blood flow, often thickening of the scrotal wall, hydrocele, and funiculitis. (e) Primary vascular testicular damage: increased testicular volume, focal or diffuse decrease/absence of testicular blood flow, absent twisting of the spermatic cord. (f) Testicular torsion: twisting of the spermatic cord, redundant spermatic cord in the scrotal sac, rotated testis, increased volume, decrease in/absence of testicular blood flow, sometimes hydrocele and thickening of the scrotal wall.