Fournier Gangrene: Role of Imaging

Abstract

Fournier gangrene is a rapidly progressing necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency with a potentially high mortality rate. Although the diagnosis of Fournier gangrene is often made clinically, emergency computed tomography (CT) can lead to early diagnosis with accurate assessment of disease extent. CT not only helps evaluate the perineal structures that can become involved by Fournier gangrene, but also helps assess the retroperitoneum, to which the disease can spread. Findings at CT include asymmetric fascial thickening, subcutaneous emphysema, fluid collections, and abscess formation. Subcutaneous emphysema is the hallmark of Fournier gangrene but is not seen in all cases. Compared with radiography and ultrasonography, CT provides a higher specificity for the diagnosis of Fournier gangrene and superior evaluation of disease extent; however, diagnosis and evaluation can also be performed with these other modalities. The administration of broad-spectrum antibiotics and aggressive surgical débridement of the nonviable tissue are both essential for successful treatment. An awareness of the CT features of Fournier gangrene is imperative for prompt diagnosis and effective treatment planning.

Management Of Fournier’s Gangrene Secondary To Traumatic Urethral Catheterisation

“…Palpable crepitation on physical examination and foul-smelling exudate with small necrotic areas of skin around erythema and edema are the most important signs (3,4). On diagnostic evaluation, conventional radiography, ultrasonography and computed tomography or magnetic resonance imaging to describe para-rectal involvement can facilitate diagnosis and disease management (6). Surgical debridement of FG must be early (<24 h) and completely, with adequate fluid resuscitation and electrolyte therapy, mostly in the intensive care setting as well as parenteral broad-spectrum antibiotic therapy which covers all causative organisms (metronidazole, penicillin and third generation cephalosporin or aminoglycosides) (4,7).…”

A clinical case of Fournier’s gangrene: imaging ultrasound

“…The spread of infection is along the facial planes and is usually limited by the attachment of the Colles' fascia in the perineum. Infection can spread to involve the scrotum, penis and the anterior abdominal wall, along the Scarpa fascia [14]. The testes are usually spared as their blood supply originates intraabdominally [5].…”

“…CT scan shows asymmetric fascial thickening, any coexisting fluid collection or abscess, fat stranding around the involved structures, and subcutaneous emphysema secondary to gasforming bacteria [7]. The underlying cause of the Fournier's gangrene, such as a perianal abscess, a fistulous tract, or an intra-abdominal or retroperitoneal infectious process, may also be demonstrated better at CT [17].…”

Distant subcutaneous spreading of Fournier’s gangrene: An unusual clinical identification by preoperative ultrasound study

“…The patient's medical history was remarkable for a history of hypertension and diabetes mellitus, diagnosed twenty years ago. On admission, his vital signs were as follows: blood pressure 135/80 mmHg; heart rate 98 bpm and an early diagnosis is important because immediate surgical debridement and aggressive antibiotic treatment are indicated (1,3). Thorough physical examination and clinical assessment are favourable for a correct diagnosis of FG, but laboratory studies and imaging can be useful for risk stratification and to identify a potential source, respectively.…”

“…His blood count showed: haemoglobin level, 11.3 g/dL, white blood cell count, 17.000/mm 3 , and platelet count, 185.000/mm 3 . C-reactive protein level was 13 mg/dL, glucose 280 mg/ dL and creatinine level was 1.4 mg/dL.…”