Presentation
Concern for abscess and soft tissue infection of the penis/scrotum.
Patient Data
Soft tissue thickening and enhancement about the glans penis. Foley catheter within the decompressed bladder. Scrotal enlargement, soft tissue thickening, and edema. Small hydroceles with calcifications in the right scrotal sac.
Large, peripherally enhancing and centrally low attenuation necrotic inguinal lymph nodes or fluid collections., Subtle, smaller areas of abnormal nodal tissue along the common femoral chain anterior to the acetabular columns at the level of hip arthroplasty, obscured by artifact. Note of anterior projecting bladder diverticulum. Small presumed ganglion cyst tracking up the atrophic right psoas muscle.
Patient is status post distal penectomy (not imaged). A few areas of soft tissue stranding are noted within the lower scrotum/perineum, also not well characterized.
Pigtail catheters within each inguinal collection/necrotic lymph node. Slightly decreased size of the left with similar size of the right. Enlarging common femoral chain lymph nodes anterior to the acetabula, again obscured by metallic artifact. Also enlarging metastatic lymph node in the left common iliac chain.
Case Discussion
This case nicely illustrates the overlapping appearance of necrotic nodal metastases from squamous cell carcinoma and abscesses.
This patient was initially imaged for concern for soft tissue swelling and abscess of the penis/scrotum. The area of soft tissue thickening about the glans penis was not appreciated to represent a primary tumor at the time of initial imaging. Given that history, the very large inguinal lymph nodes were stated to represent necrotic lymph nodes or abscesses. The smaller but abnormal common femoral chain lymph nodes obscured by metallic artifact were not appreciated at the time of initial imaging.
The patient was evaluated by urology and diagnosed with squamous cell carcinoma of the penis, and underwent distal penectomy.
The patient had persistent leukocytosis of 25,000 following surgery, and the decision was made to place pigtail catheters into the necrotic lymph inguinal lymph nodes with the concern of the could be superinfected or abscesses. The fluid culture to the pigtail catheters returned as malignant cells, consistent with squamous cell carcinoma. Additionally, the follow-up examination can see an enlargement of the common femoral left common iliac chain nodal metastases. It is generally discouraged to attempt to drain necrotic nodal metastases.
Unable to process the form. Check for errors and try again.