Fournier’s gangrene is a rapidly progressing polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions. Because of its high mortality rate, immediate diagnosis and intervention are non-negotiable.
As illustrated by Paul Nikolaidis, MD, during the ARRS Online Course Imaging of Pathologies of Male External Genitalia, this surgical emergency typically affects middle-aged men—particularly those with risk factors like diabetes, indwelling catheters, recent surgery, or immunosuppression from cancer treatments.
- Down & Dirty? Look for dirty shadowing or ring-down artifacts caused by gas within the soft tissues, along with significant skin thickening.
- Notable Normality: The testes, themselves, usually appear normal, as the infection follows fascial planes, rather than involving the scrotal contents directly.
- Gold Map: CT comes in clutch in the ED to confirm the diagnosis and, more importantly, to show the extent of involvement for the surgical team.
Whereas imaging is vital, roughly 10% of patients will not show visible gas on initial scans; therefore, clinical suspicion must remain high (even if those classic dirty shadows are absent).
RadFYI: Early diagnosis is the only way to ensure survival. Once identified, management must include aggressive antibiotic therapy and immediate surgical debridement of all affected areas.
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