PURPOSE: To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management. MATERIALS AND METHODS: Fourteen patients with surgically proved necrotizing fasciitis of the extracranial head and neck were examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after initial treatment were analyzed retrospectively. RESULTS: Constant CT features of necrotizing fasciitis were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck compartments. Inconstant CT features included gas collections, mediastinitis, and pleural or pericardial effusions. All patients underwent extensive surgical debridement. Follow-up CT scans in 11 patients revealed clinically unsuspected progression of the inflammatory process in previously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and medical treatment. CONCLUSION: Early recognition of necrotizing fasciitis with CT enables appropriate surgical treatment. CT may also be a useful guide in further patient treatment after initial surgical debridement.
PURPOSE: To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management. MATERIALS AND METHODS: Fourteen patients with surgically proved necrotizing fasciitis of the extracranial head and neck were examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after initial treatment were analyzed retrospectively. RESULTS: Constant CT features of necrotizing fasciitis were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck compartments. Inconstant CT features included gas collections, mediastinitis, and pleural or pericardial effusions. All patients underwent extensive surgical debridement. Follow-up CT scans in 11 patients revealed clinically unsuspected progression of the inflammatory process in previously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and medical treatment. CONCLUSION: Early recognition of necrotizing fasciitis with CT enables appropriate surgical treatment. CT may also be a useful guide in further patient treatment after initial surgical debridement.
Authors: Francesco Carbonetti; Antonio Cremona; Valentina Carusi; Marco Guidi; Elsa Iannicelli; Marco Di Girolamo; Daniela Sergi; Alvise Clarioni; Giulio Baio; Giulio Antonelli; Luca Fratini; Vincenzo David Journal: Radiol Med Date: 2015-08-19 Impact factor: 3.469
Authors: Tatiana Piedra; Laura Martín-Cuesta; Javier Arnáiz; Enrique Marco de Lucas; Raúl Pellón; Ana García-Bolado; Francisco González Journal: Emerg Radiol Date: 2007-01-10