Atypical CT Finding in the Scrotum

​BY DILEM POLAT &KHALID MALIK, MDA 50-year-old man with hypertension presented to the emergency department with an exacerbation of his lower back and perianal pain that he had had for two weeks, with a new onset of active fecal draining and difficulty urinating for four hours. He said he had no headache, nausea, vomiting, weakness, fatigue, fever, and chills, and all other reviews of systems were negative.His temperature was 98.5°F, blood pressure was 108/57 mm Hg, pulse rate was 113 bpm, respiratory rate was 20 bpm, and oxygen saturation was 97% on room air. His abdomen was soft, mildly distended, and not tender to palpation with normal bowel sounds. His rectum was edematous with indurated perianal tissue. Digital rectal exam was deferred due to draining stool.Contrast-enhanced CT of the abdomen and pelvis was obtained, which revealed the presence of air within the bilateral ischiorectal fossa with air extending anteriorly into the right scrotum. (Photo.) Fluid was also present along the bilateral levator ani. A diagnosis of Fournier's gangrene was made.\Contrast-enhanced CT of the abdomen and pelvis showing air extending into the right scrotum (shown in black).The patient was promptly started on fluid resuscitation and triple antibiotics—piperacillin-tazobactam 3.375 g, metronidazole 500 mg, and vancomycin 1 g. Morphine 4 mg IV push was given for pain, and the patient was hospitalized for surgical debridement. He became stable and was discharged without any ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
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Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
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