Case Study - March 2008

This is a pelvic MRI scan in a 32-year-old man with perineal discomfort, pyrexia and bluish discoloration of the scrotal skin.

  1. What does the MRI show?
  2. What is the most likely diagnosis?
  3. What treatment should be given?

Case presented by Mr Tev Aho


Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. There is gas in the left side of the perineum and in the scrotum itself. Further views (not shown) confirmed that this gas extended into the ischiorectal fossa
  2. This is most likely to be Fournier's gangrene of the scrotum. However, perianal sepsis is the precipitating factor in some patients and was the underlying cause of his scrotal gangrene
  3. Treatment is broad-spectrum antibiotics and radical surgical debridement of all infected tissues. This may need to be repeated if the gangrene progresses and can often leave the scrotal contents denuded (see below), requiring skin grafting at a later stage

illustrative image for answer to question $n

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