Frostbite

Last revised by Mostafa Elfeky on 2 Jul 2023

Frostbite is a focal tissue injury from exposure to extremely low temperatures, and most commonly involves the fingers and toes. It is most commonly encountered in radiology in a differential for acro-osteolysis.

Most common on exposed areas: hands, feet, face and ears. The skin changes texture ("waxy") and may develop bullae if the frostbite is severe. 

Tissue injury from frostbite occurs in two ways 1:

  • direct tissue necrosis from freezing

  • indirect tissue injury from inflammatory changes and release of inflammatory mediators

May be useful to help determine the degree of injury or presence of secondary injury in patients who present clinically with frostbite.

  • acro-osteolysis of the distal phalanx / phalangeal tuft

  • swelling of affected soft tissues

  • it has been reported that the thumb may be relatively spared (the patient is likely to wrap their thumb in their palm) 2

Limited data suggests that MRI may be a useful modality for demarcating ischemic tissue 4.

A two-phase scan may be useful to assess the viability of tissue 3. A combination of the perfusional phase and soft tissue phase can help characterize areas of inflammation and areas of ischemia (increased or decreased radiotracer activity, respectively).

Clinically, frostbite is classified similarly to burns: 1st-4th degree.

Incautious thawing of the tissue may lead to worsened injury (higher degree burn) from the ensuing inflammatory reaction.

Treatment of systemic hypothermia should be prioritized over frostbite.

Imaging differentials are that of acro-osteolysis.

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.