Presentation
Perineal pain.
Patient Data
Centered on the left scrotum is a 4.7 x 6.2 x 6.8cm cystic lesion with peripheral contrast enhancement. There is fat stranding associated with the remainder of the scrotum extending posteriorly in the subcutaneous tissues to towards the anus and superiorly towards the base of the penis. No associated gas. The spermatic cords on both sides are thickened and are hyperdense (~50HU) and this more likely represents venous engorgement rather than infection.
Prostatomegaly. Centered on the right bladder is a lobulated, enhancing mass that indents into the bladder. The bladder itself is collapse. Colonic fecal loading. No enlarged lymph nodes. No suspicious bone lesions.
Conclusion:
- Superficial Scrotal abscess. Fat stranding indicative of associated cellulitis.
- Mass lesion projecting into the left inferior bladder likely arises from an enlarged prostate. Cystoscopy could help clarify this.
Case Discussion
Clinically, this case presented as Fournier gangrene but subsequent investigation demonstrated a superficial scrotal abscess. Ultrasound (not shown) demonstrated normal testicular Doppler flow and this abscess separate to the testes.
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