Idiopathic scrotal hematoma in newborns: a case report and literature review

Neonatal acute scrotum is an uncommon condition, with testicular torsion being the most critical differential diagnosis. Idiopathic scrotal hematoma is a rare entity characterized by scrotal swelling and discoloration, with preserved testicular perfusion. Differentiating idiopathic scrotal hematoma from testicular torsion is challenging but essential to avoid unnecessary surgery. We report a case of a newborn who presented with scrotal swelling and discoloration at 72 h of life. Doppler ultrasound revealed preserved testicular blood flow, and abdominal ultrasound excluded intra-abdominal pathology. The patient was diagnosed with idiopathic scrotal hematoma and managed conservatively. A review of 16 cases of neonatal idiopathic scrotal hematoma highlights its diagnostic challenges and the potential for misdiagnosis. While early reports emphasized surgical exploration, advances in imaging, particularly Doppler ultrasound, now allow for non-invasive diagnosis and conservative management.