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Fournier gangrene: pictorial review

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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.

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Authors and Affiliations

  1. Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand

    Sirote Wongwaisayawan

  2. Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada

    Sirote Wongwaisayawan, Mohammad Haroon, Yashmin Nisha & Adnan Sheikh

  3. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    Satheesh Krishna

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  1. Sirote Wongwaisayawan
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SW contributed to conceptualization, literature review, draft the article, critically review the article, and approve the final manuscript; SK, MH, YN, and AS contributed to conceptualization, critically review the article, and approve the final manuscript.

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Correspondence to Sirote Wongwaisayawan.

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Wongwaisayawan, S., Krishna, S., Haroon, M. et al. Fournier gangrene: pictorial review. Abdom Radiol 45, 3838–3848 (2020). https://doi.org/10.1007/s00261-020-02549-9

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  • DOI: https://doi.org/10.1007/s00261-020-02549-9

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