Accuracy of point‑of‑care ultrasonography in the diagnosis of necrotizing fasciitis: A case report
- Authors:
- Wesley Cardona‑Castro
- Mateo Zuluaga‑Gómez
- Daniel González‑Arroyave
- Carlos Martín Ardila
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Affiliations: Department of Emergency Medicine, Faculty of Medicine, University of Antioquia, UdeA, Medellín, Antioquia 050010, Colombia, Department of Medicine, San Vicente Fundación Hospital, Rionegro, Antioquia 054047, Colombia, Department of Basic Studies, Faculty of Dentistry, University of Antioquia, UdeA, Medellín, Antioquia 050010, Colombia
- Published online on: October 26, 2022 https://doi.org/10.3892/br.2022.1581
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Article Number:
98
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Abstract
Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42‑year‑old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non‑productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical‑mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point‑of‑care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.
View References
|
1
|
Fernando SM, Tran A, Cheng W, Rochwerg B,
Kyeremanteng K, Seely AJE, Inaba K and Perry JJ: Necrotizing soft
tissue infection: Diagnostic accuracy of physical examination,
imaging, and LRINEC score: A systematic review and meta-analysis.
Ann Surg. 269:58–65. 2019.PubMed/NCBI View Article : Google Scholar
|
|
2
|
Tso DK and Singh AK: Necrotizing fasciitis
of the lower extremity: Imaging pearls and pitfalls. Br J Radiol.
91(20180093)2018.PubMed/NCBI View Article : Google Scholar
|
|
3
|
Lahham S, Shniter I, Desai M, Andary R,
Saadat S, Fox JC and Pierce S: Point of care ultrasound in the
diagnosis of necrotizing fasciitis. Am J Emerg Med. 51:397–400.
2022.PubMed/NCBI View Article : Google Scholar
|
|
4
|
Lin CN, Hsiao CT, Chang CP, Huang TY,
Hsiao KY, Chen YC and Fann WC: The relationship between fluid
accumulation in ultrasonography and the diagnosis and prognosis of
patients with necrotizing fasciitis. Ultrasound Med Biol.
45:1545–1550. 2019.PubMed/NCBI View Article : Google Scholar
|
|
5
|
Sideris G, Nikolopoulos T and Delides A:
Cervical necrotizing fasciitis affects only immunocompromized
patients? Diagnostic challenges, treatment outcomes and clinical
management of eleven immunocompetent adult patients with a still
fatal disease. Am J Otolaryngol. 41(102613)2020.PubMed/NCBI View Article : Google Scholar
|
|
6
|
Subramaniam S, Bober J, Chao J and
Zehtabchi S: Point-of-care ultrasound for diagnosis of abscess in
skin and soft tissue infections. Acad Emerg Med. 23:1298–1306.
2016.PubMed/NCBI View Article : Google Scholar
|
|
7
|
Hakkarainen TW, Kopari NM, Pham TN and
Evans HL: Necrotizing soft tissue infections: Review and current
concepts in treatment, systems of care, and outcomes. Curr Probl
Surg. 51:344–362. 2014.PubMed/NCBI View Article : Google Scholar
|
|
8
|
Kaafarani HM and King DR: Necrotizing skin
and soft tissue infections. Surg Clin North Am. 94:155–163.
2014.PubMed/NCBI View Article : Google Scholar
|
