Imaging Case: 74 Year Old Male with Rectal Pain and Fatigue

Wed, 12/14/2016 - 12:29pm
Author: 
Lauren Murphy, MD
Editor: 
Hope Kilgannon, MD
Joseph Cesarine, MD

Case: A 74 yo male patient with a PMH significant for rectal carcincoma (s/p chemotherapy and radiation; refused surgery) arrives with chief complaint of rectal pain and general malaise for two week duration.  He notes urinary and fecal incontinence over this same time period.  He also notes intermittent fevers.

Vital Signs:
Temp: 97.2 F
HR: 114
BP: 140/92
RR: 16
SpO2 95% on RA

Physical Exam: Thin elderly male, appearing tired; heart sounds within normal limits; lung sounds with rales at bases; GU exam significant for an edematous and erythematous scrotum extending to the perineum, without bullae, bruising, or crepitus.  The area is significantly tender.

A CT of the abdomen and pelvis is obtained which is significant for the images below:

At the level of the perineum below the femoral head:

This image shows the perineum and rectum at the level of the base of the ischial tuberosity:

And this image is at the level of the acetabulum including bladder and rectum:

What is Diagnosis?
A) Cellulitis of the Scrotum
B) Fournier's Gangrene
C) Scrotal Abscess
D) Incarcerated Indirect Hernia
E) Varicocele

ANSWER