Diagnosing Scrotal Fournier's Gangrene Using Point of Care Ultrasound in the Emergency Department
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-8-2026
Abstract
Fournier's gangrene is a rare, rapidly progressive necrotizing soft tissue infection of the perineum and scrotum associated with sepsis and high mortality. Survival depends on early recognition and urgent surgical intervention; however, diagnosis is frequently delayed due to nonspecific early findings and reliance on advanced imaging such as computed tomography. Point-of-care ultrasound (POCUS) offers a rapid bedside modality capable of detecting subcutaneous gas, fascial thickening, and fluid collections suggestive of necrotizing infection. This case illustrates how POCUS enabled early diagnosis of scrotal Fournier's gangrene in the emergency department, expediting definitive management well before confirmatory imaging was obtained.
A 69-year-old male presented to the emergency department with three to four days of progressive scrotal pain and swelling. His medical history was significant for hypertension, hyperlipidemia, chronic tobacco use, and alcoholic cirrhosis with ascites. Several days prior, hot coffee contacted his scrotum following an episode of emesis, causing immediate discoloration and discomfort. Symptoms progressed to severe pain with increasing swelling, erythema, and skin darkening. On arrival, the patient was hypotensive and tachycardic. Physical examination revealed an acutely ill patient with an enlarged, foul-smelling, markedly tender scrotum and areas of necrosis involving the inferior scrotal wall. Laboratory studies later demonstrated leukocytosis, elevated lactate, acute kidney injury, metabolic acidosis, and elevated creatine kinase, consistent with severe systemic infection.
This case demonstrates the critical role of point-of-care ultrasound in the early diagnosis of Fournier's gangrene in the emergency department. POCUS enabled rapid identification of subcutaneous gas and necrotizing infection, prompting early resuscitation and urgent surgical consultation well before confirmatory imaging. Incorporation of bedside ultrasound in suspected necrotizing soft tissue infections may reduce diagnostic delays and accelerate life-saving interventions.
Recommended Citation
Casella J. Diagnosing scrotal fournier's gangrene using point of care ultrasound in the emergency department. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2030