Fournier Gangrene in Men and Women: Appearance on CT, Ultrasound, and MRI and What the Surgeon Wants to Know

Abstract

Fournier gangrene (FG) is a genitourinary necrotizing fasciitis that can be lethal if not promptly diagnosed and surgically debrided. The diagnosis is often made by physical examination paired with an appropriate clinical suspicion and supporting laboratory values. Imaging, particularly computed tomography (CT), plays a role in delineating involved fascial planes for operative debridement and occasionally in diagnosing FG. Less commonly, the imaging manifestations of FG may also be seen on ultrasound, radiographs, and magnetic resonance imaging. With the ubiquitous use and availability of CT, radiologists have a growing role in recognizing FG. This can be challenging in the absence of fascial gas, but a CT scoring system for necrotizing fasciitis can be helpful in making the diagnosis. Recent series suggest that this predominantly male disease has a rising incidence in women. Women with FG are more likely to be morbidly obese and have vulvar or labial involvement compared to men. Imaging mimics include ulcerative and necrotic tumors, traumatic or iatrogenic fascial gas, and vaginitis emphysematosa. The purpose of this pictorial review is to illustrate the imaging manifestations of FG and its mimics, with emphases on necrotizing fasciitis CT scoring systems and FG in women.

Técnica De Tunelização Do Testículo Exposto E Importância Do Conhecimento Da Anatomia Na Gangrena De Fournier

“…Após a isquemia e trombose, ocorre a disseminação de bactérias, sendo as anaeróbicas produtoras de gases, responsáveis pela crepitação, encontrada nas primeiras 48 horas da infecção 13 , que pode se desenvolver sob a pele aparentemente normal 14,15 . Os microrganismos com maior prevalência são Escherichia coli, Staphylococcus aureus e…”

“…Bacteróides fragilis e Streptococcus fecalis 13,14,16,17 . A redução da taxa de mortalidade depende do diagnóstico precoce e do início rápido dos tratamentos com antibióticos de amplo espectro 18,19,20,21 , desbridamentos dos tecidos necrosados ,22,23,24,25 e a associação da terapia hiperbárica 26,27,28,29 .…”

Gangrena de Fournier vulvar

“…La presencia de gas subcutáneo puede ser detectada por radiografía, ecografía, tomografía computarizada y resonancia magnética. La ecografía es el método más útil, ya que permite el diagnóstico diferencial con otros procesos patológicos menos intensos, como edema o celulitis (3) .…”

“…La gangrena de Fournier es una condición muy rara en mujeres. La frecuencia informada es de 1,6 casos / 100 000 de la población masculina y con relación de casos masculinos / femeninos que supera la proporción 10:1 (3) . Los casos que aparecen en vulva son comúnmente subdiagnosticados, lo que generalmente lleva a diagnósticos erróneos y falla del tratamiento durante la fase aguda, por lo que la alta tasa de mortalidad es mayor comparada con la de los hombres (2) .…”

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

“…Another tool that can be used to make a quick diagnosis is ultrasonography (US). The presence of subcutaneous gas in the perineum and the scrotal area appears as a "dirty" acoustic shadowing on US imaging [48]. The most specific imaging modality for determining the extent of infection is computed tomography (CT), which allows surgical teams to plan debridement accordingly [49].…”