eMedicine Specialties > Emergency Medicine > Genitourinary

Fournier Gangrene: Differential Diagnoses & Workup

Author: Michael T Marynowski, DO, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Coauthor(s): Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Mar 4, 2008

Differential Diagnoses

Balanitis
Hydrocele
Cellulitis
Necrotizing Fasciitis
Epididymitis
Orchitis
Gas Gangrene
Testicular Torsion
Hernias

Other Problems to Be Considered

Testicular fracture
Testicular hematoma
Testicular abscess
Scrotal abscess
Vasculitis
Warfarin gangrenosum
Polyarteritis nodosum
Wegener granulomatosis

Workup

Laboratory Studies

  • Complete blood count (CBC)
  • Electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose levels
    • Acidosis with hyperglycemia or hypoglycemia may be present.
    • Dehydration occurs as the disease progresses.
  • Arterial blood gas (ABG) sampling may provide a more accurate assessment of acid/base disturbance.
  • Blood and urine cultures
  • DIC panel (coagulation studies, fibrinogen/fibrin degradation product levels) may provide evidence of severe sepsis.
  • Cultures of any open wound or abscess

Imaging Studies

  • Diagnosis of Fournier gangrene primarily is based on clinical findings. Sensitivities and specificities of different radiologic modalities are not established.
  • Conventional radiography
    • Conventional radiography may demonstrate soft-tissue gas collections (manifest as areas of hyperlucency), even before they are clinically apparent.
    • Scrotal tissue edema may be observed on radiographs.
    • Absence of air on plain films does not exclude the diagnosis.
  • Ultrasonography
    • Ultrasonography may reveal other causes of acute scrotal pain, including intratesticular injury, scrotal cellulitis, epididymoorchitis, testicular torsion, and inguinal hernia.
    • Gas in the scrotal wall is the "sonographic hallmark" of Fournier gangrene.
    • Air may be appreciated in perineal and/or perirectal areas.
    • Scrotal wall edema may be seen.
    • Testes and epididymides usually are normal.
  • Computed tomography
    • Findings include soft-tissue and fascial thickening, fat stranding, and soft-tissue gas collections.
    • CT scan defines the extent of the disease more specifically than plain films or ultrasound.
    • CT scan often identifies the underlying cause of the infection (eg, perirectal abscess).
    • This modality may assist in surgical planning.
  • Magnetic resonance imaging
    • MRI use is not well described in the literature.
    • MRI may define soft-tissue pathology more distinctly than CT scan but should not delay operative intervention if the diagnosis is highly suspected.

More on Fournier Gangrene

Overview: Fournier Gangrene
Differential Diagnoses & Workup: Fournier Gangrene
Treatment & Medication: Fournier Gangrene
Follow-up: Fournier Gangrene
References
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References

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Further Reading

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Keywords

Fournier gangrene, Fournier's gangrene, gangrene of the penis and scrotum, polymicrobial necrotizing fasciitis, infection of superficial perineal fascia

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Contributor Information and Disclosures

Author

Michael T Marynowski, DO, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Andrew A Aronson, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard Lavely, MD, JD, MS, MPH, Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine
Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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