Fountain sign
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CLASSICS IN ABDOMINAL RADIOLOGY
Fountain sign Venkatraman Indiran1 · Kanakaraj Kannan1 · T. Ramachandra Prasad1 · Prabakaran Maduraimuthu1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Increased vascularity seen in the thickened scrotal wall on transverse images on color Doppler ultrasound in patients with acute idiopathic scrotal edema (AISE) resembles a color fountain and is called as the fountain sign (Figs. 1, 2) [1]. AISE, a benign dermatosis characterized by selfresolving scrotal edema and erythema of short duration, accounts for about 3–20% of cases of acute scrotum [2]. AISE primarily affects children, but may also occur in adults [3]. AISE presents as scrotal edema, pain with or without intense scrotal pruritus [3]. Scrotal pain occurs due to stretching of the scrotal skin from edema. Scrotal skin and dartos fascia became erythematous and edematous in AISE with the testes and epididymis appearing normal in echoes and vascularity [4]. Hypervascularity of the scrotal wall, due to increased flow in the anterior and posterior scrotal arteries resembles a color fountain on color Doppler ultrasound [1]. AISE may also involve the groin, perineum, penis, and suprapubic region [5]. Differential diagnoses for acute scrotum include epididymitis, testicular torsion, and testicular appendage torsion, which have to be excluded by color Doppler ultrasound before diagnosing AISE [2]. AISE usually resolves spontaneously by 3 to 5 days, or with nonsteroidal anti-inflammatory drug, but can recur in about 20% of cases [2, 5].
Fig. 1 Transverse color Doppler ultrasound images show hypervascularity in the thickened scrotal wall resembling a color fountain in a patient with acute idiopathic scrotal edema [Fountain sign] (white arrows)
* Venkatraman Indiran [email protected] 1
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu 600044, India
Fig. 2 Photograph showing Trafalgar Square LED Fountains. ( Source: https://upload.wikimedia.org/wikipedia/commons/6/67/Trafa lgar_Square_LED_Fountains_-_June_2009.jpg)
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Author contributions All authors contributed equally in the collection of data, interpretation of the data, and preparation of manuscript. Funding There is no funding.
Compliance with ethical standards Conflict of interest Author declares that they have no conflicts of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from individual participant included in the study. Research involving human and animal rights This article does not contain any studies with animals performed by any of the author(s).
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Abdominal Radiology
References 1. Geiger J, Epelman M, Darge K. (2010) The fountain sign: a novel co
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