A 47 y/o man with LBP and fever

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Arash Mohammadi Azar

Case Section

Uroradiology@Genital male imaging

Patient's Information

Gender : Male
Age : 47

Clinical Summary

A47 Y/O man with history of diabetes mellitus presented with LBP and fever and swelling of scrotum

Imaging Findings

CT section images demonstrate Extraperitoneal air throughout abdominopelvic cavity with fat stranding and extention to left scrotal .

Differential Diagnosis

Cellulitis; Strangulated hernia; Scrotal abscess; Streptococcal necrotising fascitis; Vascular occlusion

Final Diagnosis

Fournier gangrene

Discussion (Related Text)

Although the diagnosis of Fournier gangrene is most commonly made clinically, CT can be valuable in patients in whom the diagnosis is unclear or the extent of disease is difficult to discern . CT has greater specificity for evaluating disease extent than does radiography, US, or physical examination .The etiology of the gangrene, anatomic pathways of spread, and presence of any fluid collection or abscess are best assessed with CT. Furthermore, subcutaneous emphysema and its extent, including retroperitoneal extension, are well evaluated at CT.The CT features of Fournier gangrene include soft-tissue thickening and inflammation. CT can demonstrate asymmetric fascial thickening, any coexisting fluid collection or abscess, fat stranding around the involved structures, and subcutaneous emphysema secondary to gas-forming bacteria . The subcutaneous emphysema in Fournier gangrene dissects along fascial planes and can extend from the scrotum and perineum to the inguinal regions, thighs, abdominal wall, and retroperitoneum .The underlying cause of the Fournier gangrene, such as a perianal abscess, a fistulous tract, or an intraabdominal or retroperitoneal infectious process, may also be demonstrated at CT . In cases caused by colonic perforation, not only does CT demonstrate extraluminal foci of air, but extravasation of enteric contrast material may also be seen . The extent of fascial thickening and fat stranding seen at CT has been found to correlate well with the affected tissue at surgery . In early Fournier gangrene, CT can depict progressive soft-tissue infiltration, possibly with no evidence of subcutaneous emphysema. Because the infection progresses rapidly, the early stage with lack of subcutaneous emphysema is brief and is rarely seen at CT . Posttreatment follow-up CT is valuable in assessing for improvement or worsening of disease to determine if additional therapy or surgery is needed.

References

http://radiographics.rsna.info/content/28/2/519.full