Presentation
Painless testicular symptoms, longstanding with abdominal pains.
Patient Data
Multiple variable sized sub-centimeter foci of increased hyperechoicity (pearl white) and subtle posterior acoustic shadowing are noted within the bilateral scrotal sacs consistent with scrotoliths. The largest on the right measures 4.3 mm in diameter. Mild bilateral scrotal sac hydroceles is noted (right>left).
Case Discussion
Numerous bilateral extra-testicular foci with vivid echo reflectivity and subtle posterior acoustic shadowing that shows no significant twinkling artifacts on color Doppler, are seen within the bilateral scrotal sacs representing scrotal pearls a.k.a scrotoliths or scrotal calculi and are located at the tunica vaginalis layer with a few on the left conglomerated on the left epididymal appendix. Most literature points that scrotal calculi are identified in 50% of patients and results either from hematomas, inflammation or repeated microtrauma and are mostly composed of fibrinoid deposits around a central nidus of hydroxyapatite 1-3.
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