What is the role of plain radiography in the workup of Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Radiography should be considered to evaluate for the presence and extent of Fournier gangrene, especially when the clinical examination findings are inconclusive. [60, 61] Gas within the soft tissues is detected more commonly with imaging modalities than with the physical examination. (Note that in the setting of a clinical suspicion of Fournier gangrene, demonstration of soft-tissue gas or detection of subcutaneous crepitation is an absolute indication for surgical exploration.)

Plain radiography should be the initial imaging study. It may reveal moderate-to-large amounts of soft-tissue gas, foreign bodies, or scrotal tissue edema. Soft-tissue gas collections, which manifest as areas of hyperlucency, may be evident on radiography before they become clinically apparent. However, the absence of air on plain films does not exclude the diagnosis.

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