Emergency diagnosis of Fournier's gangrene with bedside ultrasound
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Fig. 1
The patient's swollen scrotum is shown.
Fig. 2
A focal collection (arrows) of gas is seen in the scrotum.
Fig. 3
A plain x-ray of the pelvis and scrotum showing scrotal gas (arrows).
Fig. 4
Two loops of bowel (arrows) are seen in the scrotum with occasional specs of bowel gas.
Abstract
Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene. In patients with low to moderate suspicion of Fournier gangrene, it may provide a rapid and reliable diagnosis and differentiate the pathological process from mimicking entities such as scrotal edema or cellulitis. We present 6 cases of Fournier's gangrene diagnosed in the ED at the patient's bedside using ultrasound. None of the patients had a history of diabetes, and 5 had sources of infection determined.
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