Solution: Henoch-Schonlein purpura (HSP) is a childhood systemic vasculitis involving the skin, gastrointestinal tract, joint, kidneys and even scrotum. In fact, in some studies, up to 20% of children with this disease have scrotal involvement with epididymitis being the most common finding. Since the syndrome is a systemic vasculitis, the symptoms are often variable and non-specific, thus leading to misdiagnosis and mis-management. Therefore, one should be aware of these associations. br />
The imaging findings in this case are typical of epididymitis, but of course, the age group is unusual, making the diagnosis less certain. Pertinent negatives include normal appearance and blood flow in the testicle, excluding testicular torsion. However, there is very significant hyperemia of the epididymitis.