Necrotizing fasciitis: Early sonographic diagnosis

Abstract

Necrotizing fasciitis is a rare, but potentially fatal bacterial infection of the soft tissues. Establishing the diagnosis at the early stages of the disease remains the greatest challenge. We report a case ofnecrotizing fasciitis involving the upper extremity. Sonography revealed subcutaneous emphysema spreading along the deep fascia, swelling, and increased echogenicity of the overlying fatty tissue with interlacing fluid collections. The patient responded well to early surgical debridement and parenteral antibiotics. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Ultrasound in dermatology: Principles and applications

“…Two recent reports used ultrasound to quickly diagnose necrotizing fasciitis of the upper extremity, noting subcutaneous emphysema and deep fascial thickening secondary to fluid collections and gas in the deep fascial plane. 58,59 Other clinicians have applied ultrasound for therapeutic purposes, using 25-kHz acoustic waves to rapidly and successfully achieve debridement of chronic wounds. 60 Ultrasonic imaging is also being investigated for use in diagnosis of subcutaneous benign lesions.…”

Serial Ultrasonography for Early Detection and Follow-up of Heterotopic Ossification in Stroke

“…Ultrasonography simultaneously showed a lobulated mass located between muscle planes. No typical US findings of necrotizing fasciitis such as gas formation in the soft tissues and fluid collections dissecting the deep fascia were seen, making necrotizing fasciitis less likely to be the diagnosis [22]. Subsequent ultrasonography depicted clear disease progression, with calcification visible on Day 15 of onset.…”

“…Thin enhancement of the deep fascia (82%) [15] Subcutaneous emphysema spreading along the deep fascia [22] Pyomyositis A focal, complex fluid collection of mixed echogenicity may be surrounded by a thick hyperechoic wall, which is often hyperemic.…”

“…This criterion has the sensitivity of 88.2% and specificity of 93.3% for diagnosis of NF [21]. One pathognomonic feature for NF is the presence of gas within the soft tissues [22], which can further aid the diagnosis. These features were not seen in our case.…”

An unusual infection of cervicofacial area caused by dental pathology: flesh-eating syndrome

“…Moreover, infections including cellulitis, cutaneous abscess, and peritonsillar abscess. Sonography also may reveal subcutaneous emphysema and fluid collections, allowing for early surgical treatment and parenteral antibiotics [18]. CT scan is very helpful for both diagnosis of NF and distinction of another soft tissue infections from NF.…”