Learning objectives
To review the radiological findings and diagnostic performance of the different imaging techniques in Fournier Gangrene.
Background
Fournier gangrene (FG) is a rapidly progressing type of necrotizing fasciitis involving the perineal,
perianal,
or genital regions,
and constitutes a true surgical emergency with a mortality rate that ranges from 15-70%.
The most common causes of death include sepsis,
respiratory,
renal or multisystem organ failure.
FG starts as a local infection adjacent to the point of entry that results into inflammation and edema,
leads to impared local blood supply,
vascular thrombosis of the cutaneous and subcutaneos tissues,
and finally,
perifascial dissection with spread of...
Findings and procedure details
Even though the diagnosis of Fournier Gangrene is usually made clinically,
imaging may have a role.
However,
it is important to remember that in patients with negative or nonspecific imaging finding,
and a very high clinical suspicion of FG,
surgical debridement should be performed immediately,
as these patients may present with the early stage of the disease on which subcutaneous emphysema has not been stablished yet.
A-Computed tomography
Computed tomography is the method of choice in the setting of a suspicion of FG and has...
Conclusion
The CT hallmark of soft-tissue air is not always seen in Fournier Gangrene,
and its absence should not exclude necrotizing fasciitis from the differential diagnosis,
as the patient may have early disease in which gas has not yet formed or reached detectable levels.
Thus,
familiarity with subtle imaging findings of FG in the different radiological techniques is essential to facilitate a more rapid diagnosis,
which is,
together with the complete surgical debridement,
the most important prognostic factor in this type of necrotizing fascitis.
References
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Necrotizing Fasciitis and Its Mimics: What...