Clinical history:  A 7 year old male patient was admitted to the ultrasound unit, complaining of acute scrotal pain.

Clinical examination: There was a minimal examination. The patient was tender over the lower abdomen, extending down to the scrotal region.  

Past history: The patient had previously experienced an upper respiratory infection. This was treated with antibiotics and anti-inflammatory drugs. As a consequence, the condition subsided slightly but the patient then began to complain of vague lower abdominal pain, extending down to the scrotal region on both sides.

On examination using ultrasound, scrotal pyeocele (fig 1), were observed. When the investigation was continued through the inguinal canal to the lower abdomen, a minimal amount of turbid fluid was found in the right pelvic region (fig 2).

This fluid could be seen to be collected mainly around the appendix. This was retrocecal with a posterior wall defect. Pus was observed moving through the defect (fig 3). This was increasingly obvious when viewed using colour Doppler, with the appendix showing a thick hyperechoic wall, distended with pus. Multiple right pelvic mesenteric lymph node enlargement could also be seen ( fig 4). 

Please click here to view the case images in greater detail.

Click here to send BMUS an email with your diagnosis of the case. These will be posted up alongside the case information, and the correct diagnosis and treatment will be revealed in a few weeks...