Rare Diseases

Fig. 27.1

A 51-year-old male with chronic HCV-related liver disease who presented with painful, massive swelling and inflammation of the perineum, scrotum, and penis that had progressively increased in recent months. The latero-lateral radiograph (a) documents marked swelling of the scrotum and penis without detectable gas collections, thus excluding Fournier’s gangrene. Sagittal (b) and axial (c) T2-weighted images and the contrast-enhanced axial fat-suppressed T1-weighted (d) images show marked thickening of the skin and subcutaneous planes of the medial aspect of the thighs, perineal region, penis, and scrotum, all of which are involved by acute inflammation, with small pus collections. Hidradenitis suppurativa was diagnosed and the patient underwent antibiotic therapy, surgical incision, and drainage and curettage of the multiple scrotal abscesses

Almost invariably, there is no communication with the pelvic organs, including the bladder, urethra, rectum or anus; enlarged lymph nodes are present in inguinal regions [6].

MRI represents a highly valuable tool for the accurate diagnosis and assessment of disease extension and severity, as it clearly describes the anatomy of the affected area and facilitates planning of the surgical approach, which in turn reduce the risk of incomplete excision and recurrence.

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