Fournier’s Gangrene as panic event in an oncological staging FGD PET/CT: Holier Than Thou

Fournier’s Gangrene and FDG PET/CT

Abstract

Fournier’s gangrene is a rare and rapidly progressive form of necrotizing fasciitis that affects the deep and superficial tissues of the perineal, genital, anal and scrotal regions. It primarily results from polymicrobial infection and characterized by severe inflammation and infection spreading along fascial planes, often leading to rapid tissue destruction, sepsis, and a high mortality rate of 40%. Initial symptoms may mimic benign conditions such as cellulitis; therefore, early diagnosis is crucial to minimize morbidity and avoiding mortality. As one of the few urological emergencies, this condition requires prompt surgical debridement, antibiotic therapy, and medical resuscitation for effective management. We are presenting a case of elderly diabetic woman with a short history of significant morbidity with recent biopsy proven Squamous Cell carcinoma (SCC) of anterior mediastinal mass. As part of initial staging, she had FDG PET/CT which revealed nodal and pulmonary metastasis (Stage IV disease). However, PET/CT also revealed Fournier’s gangrene with imaging findings favoring septicemia and considering it a medical emergency, primary physician was immediately informed (as panic event). Early diagnosis of Fournier’s gangrene can be challenging, as 40% of patients may have no symptoms, and up to 75% of cases are initially misdiagnosed, contributing to its persistently high mortality rate. This review will focus on role of imaging in Fournier’s gangrene.

Key Words: Fournier’s gangrene; FDG; PET/CT; CT; MRI; panic event