Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Can Assoc Radiol J. 2020 Feb;71(1):30-39. doi: 10.1177/0846537119888396. Epub 2020 Jan 28.
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.
Fournier 坏疽（FG）是一种泌尿生殖系统坏死性筋膜炎，如果不能及时诊断和手术清创，可能是致命的。诊断通常通过体格检查与适当的临床怀疑和支持的实验室值相结合来做出。影像学，特别是计算机断层扫描（CT），在描绘手术清创术涉及的筋膜平面方面发挥作用，偶尔在诊断 FG 方面也发挥作用。不太常见的是，FG 的影像学表现也可能在超声、射线照相和磁共振成像上看到。随着 CT 的广泛使用和可用性，放射科医生在识别 FG 方面的作用越来越大。在没有筋膜气体的情况下，这可能具有挑战性，但是坏死性筋膜炎的 CT 评分系统有助于做出诊断。最近的系列表明，这种主要发生在男性的疾病在女性中的发病率正在上升。与男性相比，FG 女性更可能患有病态肥胖，并伴有外阴或阴唇受累。成像模拟包括溃疡性和坏死性肿瘤、创伤性或医源性筋膜气体和阴道炎气肿。本图像综述的目的是说明 FG 及其模拟物的影像学表现，重点是坏死性筋膜炎 CT 评分系统和女性 FG。
