以阴囊肿大为首发症状的坏死性筋膜炎误诊原因分析及超声特征OA

Objective To analyze the clinical characteristics,sonographic features,causes of misdiagnosis and preventive measures of necrotizing fasciitis with scrotal swelling as the initial symptom.Methods A retrospective analysis was conducted on the case data of 2 patients with necrotizing fasciitis(Fournier gangrene)of the perineum who were initially misdiagnosed as having scrotal edema and epididymal inflammatory swelling at other hospitals and were treated at the First People's Hospital of Chenzhou City from December 2025 to January 2026.Results Both cases were middle-aged male patients who presented with painless or mild discomfort in both testicles,accompanied by bilateral scrotal swelling.One case showed edema of both scrotal walls on early scrotal ultrasound,and the other case showed inflammatory edema and inflammatory swelling of the epididymal head on scrotal ultrasound.No characteristic gas echoes were observed in either case.Inflammatory edema-related lesions of the scrotum were preliminarily diagnosed,and empirical anti-infective therapy along with management of newly detected hyperglycemia(fasting blood glucose:15.5 mmol/L and 22.6 mmol/L,respectively)was initiated.However,after 10-12 d of symptomatic treatment,the condition showed no improvement and progressed rapidly within 1-2 d,manifesting as severe perianal and perineal pain,redness,swelling,and crepitus.After being transferred to our hospital,all abdominal CT examinations showed extensive inflammatory changes in the perianal,perineal and scrotal subcutaneous areas,accompanied by scattered gas shadows.The diagnosis was necrotizing fasciitis.The misdiagnosis lasted 10 d and 12 d respectively.After the two cases were diagnosed,emergency exploratory surgeries were performed,revealing extensive fascial necrosis and purulent exudate.A thorough debridement and drainage procedure was carried out.Postoperative short-term follow-up was completed,and the wounds recovered well.Conclusion Perineal necrotizing fasciitis can present as a concealed,painless swelling of the scrotum,which is prone to clinical misdiagnosis.Early high-frequency ultrasound may only show non-specific edema and lack typical gas signs,which can easily mislead the clinical diagnosis.For patients with unexplained scrotal swelling accompanied by newly detected or uncontrolled diabetes,clinicians should be highly vigilant of the possibility of necrotizing fasciitis and conduct dynamic ultrasound reexaminations and timely CT examinations to make an early diagnosis and avoid surgical delays.