Hidradenitis suppurativa

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient was referred with a 3 month history of scrotal swelling and anaemia. Testicular cancer was suspected.

Patient Data

Age: 55
Gender: Male

Ultrasound of testes

Modality: Ultrasound

There is significant subcutaneous oedema of the scrotum and penis. Both testes are within normal limits for size, echogenicity and vascularity.  No testicular mass.

Both epididymides are normal in appearance.  A few simple cysts identified bilaterally but no sinister features. No hydrocele or varicocele.

The working diagnosis following the ultrasound was "lymphoedema of unknown cause'

Modality: CT

There is marked oedema of the skin of the penis and scrotum bilaterally with enlarged nodes in both the right and left groins.  There is a large complex lobulated rim enhancing fluid collection in the left buttock, superficial to the gluteus maximus muscle.  This tracks anteriorly in the perineum towards the scrotum.  There are also multiple abnormal gas pockets surrounding the anal region suggestive of fistulae.  There is also thickening of the levator muscles.  No free fluid in the pelvis.  The rectum and sigmoid appear normal, also the bladder. No intrapelvic mass.  No abdominal adenopathy.   

Modality: MRI

There is severe, extensive, abscess formation with associated soft tissue oedema affecting the base of the penis and scrotum, perineum, subcutaneous tissues of the buttocks, ischioanal fossa and ischiorectal fossa.  Multiple complex tracts are seen.

There is no evidence of any significant supra elevator origin of the sepsis.  Some involvement of the inter sphincteric plane is shown inferiorly. Low down in the anal canal a small tract crosses the external sphincter at 6 o'clock . The intersphincteric plane is also crossed slightly higher.

Follow up 1 year later

Modality: MRI

Persistent abscess formation, fistulation and lymphadenopathy as well as severe scrotal and perineal oedema are present.

Case Discussion

The still quite dramatic changes at 1 year follow up illustrate the ling term nature of this debilitating condition. 

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Case Information

rID: 24540
Case created: 24th Aug 2013
Last edited: 29th Feb 2016
System: Urogenital
Inclusion in quiz mode: Included

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