Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand.
Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
Abdom Radiol (NY). 2020 Nov;45(11):3838-3848. doi: 10.1007/s00261-020-02549-9.
Fournier gangrene is an emergency condition that is associated with a high mortality rate. It is defined as a rapidly progressing infective necrotizing fasciitis of the perineal, perianal, and genital regions. Early diagnosis, broad-spectrum antibiotic coverage, and adequate surgical debridement are crucial and lead to better prognosis and patient survival. There is increasing utilization of computed tomography (CT) in the initial evaluation of Fournier gangrene. CT can confirm the diagnosis in equivocal cases, determine the source of infection, and evaluate the disease extent. In this pictorial review, we discuss the pathogenesis of Fournier gangrene and display the imaging spectrum with an emphasis on CT findings, including asymmetrical fascial thickening, soft tissue stranding, soft tissue gas, collection, and abscess formation. The infection originating from colorectal pathology, the affected anatomy, and the involvement of the abdominal wall are important predictors of mortality. The familiarity of the varied imaging appearance of Fournier gangrene is necessary to provide an accurate diagnosis, and evaluation of disease extent is crucial for optimal surgical debridement.
Fournier 坏疽是一种与高死亡率相关的紧急情况。它被定义为会迅速发展的感染性坏死性筋膜炎，主要影响会阴、肛周和生殖器区域。早期诊断、广谱抗生素覆盖和充分的外科清创至关重要，可改善预后和患者生存。在 Fournier 坏疽的初始评估中，越来越多地使用计算机断层扫描（CT）。CT 可在疑似病例中确认诊断，确定感染源，并评估疾病范围。在本次影像学综述中，我们讨论了 Fournier 坏疽的发病机制，并展示了影像学表现，重点是 CT 发现，包括不对称性筋膜增厚、软组织条索状影、软组织积气、积液和脓肿形成。源自结直肠病变的感染、受累解剖结构和腹壁受累是死亡率的重要预测因素。熟悉 Fournier 坏疽的多种影像学表现对于提供准确的诊断是必要的，而评估疾病范围对于最佳的外科清创至关重要。
