eMedicine Specialties > Emergency Medicine > Genitourinary
Fournier Gangrene: Differential Diagnoses & Workup
Updated: Dec 11, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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
The following studies are indicated in patients Fournier gangrene:
- CBC count
- Electrolytes, BUN, creatinine, blood glucose levels
- Acidosis with hyperglycemia or hypoglycemia may be present.
- Dehydration occurs as the disease progresses.
- ABG sampling to provide a more accurate assessment of acid/base disturbance
- Blood and urine cultures
- Disseminated intravascular coagulation (DIC) panel (coagulation studies, fibrinogen/fibrin degradation product levels) to find 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 are usually 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 |
| Multimedia: Fournier Gangrene |
| References |
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References
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Further Reading
Keywords
Fournier gangrene, Fournier's gangrene, gangrene of the penis and scrotum, polymicrobial necrotizing fasciitis, infection of superficial perineal fascia, treatment, diagnosis, symptoms
Differential Diagnoses & Workup: Fournier Gangrene