A necrotising fasciitis: case report

• Published in: Journal of ultrasound 2023-03, Vol.26 (1), p.147-150
• Main Authors: Cantarella, S., Casamassima, A., Bussone, Dott M., Baldini, E., Kersik, A., Boccia, O., Gianotti, C.
• Format: Article
• Language: English
• Subjects: Case reports; Fasciitis, Necrotizing - diagnostic imaging; Fasciitis, Necrotizing - surgery; Humans; Medicine; Medicine & Public Health; Necrosis; Original Paper; Point-of-Care Testing; Prognosis; Shadows; Soft Tissue Infections - diagnosis; Soft tissues; Swirling; Ultrasound
• ISSN: 1876-7931; 1971-3495; 1876-7931
• DOI: 10.1007/s40477-022-00717-9

Necrotizing fasciitis is one of the most common soft tissue infections, with a high risk of major amputation and a mortality ranging from 6 to 33% which has not changed in the past 20 years. Early surgical resection of necrotic tissue plays a key role in determining the prognosis. Nawijn et al. identified an optimal 6 hours window from presentation to surgery. Symptoms of necrotizing fasciitis mimic those of common skin infections, such as erysipelas and cellulitis, making rapid surgical management difficult. In this context, the aid of point-of-care-ultrasound is a valuable tool for early diagnosis, detecting the presence of subcutaneous thickening, gas and perifascial liquid. Other characteristic ultrasound findings include the "cobblestone" appearance of the subcutaneous soft tissues and reverberation artifacts due to hyperechoic outbreaks, defined as "snow globes" due to the presence of heterogeneous swirling material, and "dirty shadowing" due to the foggy shadow created by the gas.