Fournier's gangrene: ultrasound or computed tomography?

We read the case report published in the Medical Ultrasonography [1], on “Fournier’s Gangrene” by Matilsky et al with academic interest. It is appreciable that the authors have presented this rare case of necrotizing fasciitis using bedside ultrasound. However, CT scan of the abdomen and pelvis should be considered next for planned surgical management. We agree to the fact that the diagnosis of Fournier’s gangrene can be made with bedside ultrasound with a very high sensitivity [2,3]; however CT can be more specific not only in confirming the diagnosis, but also in evaluating the disease extent [4,5]. CT scan of the abdomen and pelvis can also unfold the underlying cause, as it is rare for Fournier’s gangrene to be idiopathic [4-6]. We came across a 52 year-old male diabetic patient, who presented with a 4 day history of left scrotal pain and heaviness in the ED, and was diagnosed as Fournier’s gangrene on bedside sonography (fig 1). The patient immediately underwent a CT scan of the abdomen and pelvis, which revealed subcutaneous air in the left scrotal sac, extending to the left inguinal canal, without any other focus of infection (fig 2). The CT scan solidified the plan of surgeons to perform isolated left scrotectomy, thus decreasing the overall surgical morbidity. At surgery, approximately 50 ml of foul smelling fluid was drained. Currently, the patient is planned for