Fournier gangrene: pictorial review
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REVIEW
Fournier gangrene: pictorial review Sirote Wongwaisayawan1,2 · Satheesh Krishna3 · Mohammad Haroon2 · Yashmin Nisha2 · Adnan Sheikh2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Fournier gangrene · Computed tomography · Necrotizing fasciitis · Perineum
Introduction
Epidemiology
Fournier gangrene is a urologic emergency with high mortality [1, 2]. The initial description in 1883 by Jean Alfred Fournier, a French venereologist includes three essential features: (1) abrupt onset in a young healthy male, (2) rapid progression to gangrene, and (3) absence of an identifiable cause [3]. Nowadays, the term “Fournier gangrene” is used to define a broader condition of a rapidly progressing infective necrotizing fasciitis of perineal, perianal, and genital regions [4, 5].
Fournier gangrene typically affects middle-aged men (mean age 50–60 years). The overall incidence is approximately 1.6 cases per 100,000 males [6]. Although males are more commonly affected, this condition can also affect females, with male-to-female ratio of 10:1 [1]. This is thought to be due to different perineal anatomy between males and females. Female perineum has more robust lymphatic drainage via a vaginal route which may prevent disease development [2]. It is also believed that Fournier gangrene is underreported because some clinicians continue to strictly apply the term as per its original description [1, 5].
* Sirote Wongwaisayawan [email protected] 1
Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand
2
Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
3
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women’s College Hospital, Univer
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