Haouari Mohamed Amine, Gallégo Chloé, de Parades Vincent, Fite Charlotte, Touloupas Caroline, Delpla Alexandre, Bouley-Coletta Isabelle, Zins Marc
Hôpital Paris Saint-Joseph, Paris, France.
Abdom Radiol (NY). 2025 Jul 21. doi: 10.1007/s00261-025-05128-y.
Perineal suppuration encompasses a broad spectrum of pathologies involving the anatomically complex perineal region. While anal fistula, with or without abscess, is the most frequent cause, infections may also originate from the skin, accessory urinary or genital glands, pelvic and perineal implants, or supralevator digestive structures. Clinical presentations range from benign acute episodes to severe life-threatening conditions or chronic relapsing infections. Diagnosis is often challenging due to overlapping symptoms and variable anatomical involvement. Imaging plays a pivotal role in delineating the extent and origin of disease, particularly in distinguishing anal from extra-anal sources, an essential step for appropriate management. Ultrasonography (US) and Magnetic Resonance Imaging (MRI) are well suited for evaluating anal fistulas; MRI is preferred for chronic, recurrent, or deep-seated infections, particularly those of cutaneous origin or associated with implant infection, while Computed tomography (CT) is favored for supralevator digestive involvement and Fournier's gangrene. A detailed understanding of perineal anatomy and its imaging correlates is crucial for accurate diagnosis and treatment planning. This pictorial essay illustrates the imaging features of perineal suppurations from diverse etiologies, emphasizing the diagnostic value of cross-sectional imaging and the central role of radiology in clinical decision-making.
会阴部化脓涵盖了一系列涉及解剖结构复杂的会阴部区域的病理情况。虽然肛瘘（伴或不伴脓肿）是最常见的病因，但感染也可能源于皮肤、泌尿或生殖附属腺体、盆腔与会阴部植入物或肛提肌上的消化结构。临床表现从良性急性发作到严重危及生命的状况或慢性复发性感染不等。由于症状重叠和解剖受累情况各异，诊断往往具有挑战性。影像学在明确疾病范围和起源方面起着关键作用，尤其是在区分肛瘘是源于肛门内还是肛门外，这是进行恰当治疗的关键步骤。超声检查（US）和磁共振成像（MRI）非常适合评估肛瘘；对于慢性、复发性或深部感染，尤其是皮肤源性感染或与植入物感染相关的情况，首选MRI，而对于肛提肌上消化结构受累及福尼尔坏疽，计算机断层扫描（CT）更受青睐。详细了解会阴部解剖结构及其影像学特征对于准确诊断和治疗规划至关重要。本文通过图片展示了各种病因导致的会阴部化脓的影像学特征，强调了横断面成像的诊断价值以及放射学在临床决策中的核心作用。
