Question

An elderly male patient presented with a sudden onset of scrotal pain and discharge. Based on the image below, what is the likely diagnosis?

• A. Torsion of testis
• B. Acute epididymo-orchitis
• C. Scrotal carcinoma
• D. Fournier’s gangrene

Answer 1

The Correct Option is D

In this medical scenario, we are examining the symptoms of an elderly male patient with sudden scrotal pain and discharge. Given these symptoms and the associated image, we need to identify the most probable diagnosis from the given options.

We are provided with the following potential diagnoses:

• Torsion of testis
• Acute epididymo-orchitis
• Scrotal carcinoma
• Fournier’s gangrene

The correct diagnosis for this clinical case is Fournier’s gangrene. Let's understand why this is the most likely diagnosis:

1. Fournier’s gangrene is a rapidly progressing necrotizing fasciitis that affects the perineum and genitalia, more common in older males.
2. It typically presents with sudden severe pain, swelling, and discharge, often accompanied by fever and systemic signs of infection due to the gangrenous tissue.
3. The condition often has predisposing factors such as diabetes, immune suppression, or recent trauma but can occur without these.
4. The presence of significant discharge along with pain strongly points towards a gangrenous infection rather than the other conditions listed.

Given these considerations, the other diagnoses can be ruled out:

• Torsion of testis generally presents with acute scrotal pain but without discharge. It is primarily a urological emergency concerning blood supply to the testis.
• Acute epididymo-orchitis often includes pain and swelling but typically involves less rapid progression and is also usually without significant discharge.
• Scrotal carcinoma involves a malignancy of scrotal tissue and may present with a mass or ulceration, but the acute painful presentation with discharge is atypical.

Hence, the sudden onset of severe scrotal pain with discharge and typical systemic involvement strongly suggests Fournier’s gangrene as the diagnosis.