Necrotizing fasciitis: CT characteristics

Radiology. 1997 Jun;203(3):859-63. doi: 10.1148/radiology.203.3.9169717.

Abstract

Purpose: To establish computed tomographic (CT) criteria for the diagnosis of necrotizing fasciitis.

Materials and methods: Twenty CT scans in 20 patients with pathologically proved necrotizing fasciitis were reviewed retrospectively for fascial thickening, fat infiltration, focal fluid collection, soft-tissue gas, muscle involvement, and intra-abdominal extension; the findings were correlated with clinical factors, including associated illnesses, disease site, treatment, and outcome.

Results: Average patient age was 57.8 years; there were 13 men and seven women. Four patients (20%) died. Asymmetric fascial thickening and fat stranding were seen in 16 patients (80%). Gas tracking along fascial planes was present in 11 patients (55%), and abscesses were found in seven patients (35%). Infection sites were scrotum (n = 6), a lower extremity (n = 4), perineum (n = 4), neck (n = 2), back (n = 2), arm (n = 1), and abdomen (n = 1). Underlying illness (n = 17) was diabetes in 10 patients (50%), alcoholism in three (15%), chronic renal failure in two (10%), and drug abuse in two (10%).

Conclusion: CT criteria of asymmetric fascial thickening and gas are valuable in assessing suspected necrotizing fasciitis. CT also can provide information on coexistent deep collections.

MeSH terms

  • Abscess / complications
  • Abscess / diagnostic imaging
  • Adipose Tissue / diagnostic imaging
  • Adult
  • Aged
  • Aged, 80 and over
  • Alcoholism / complications
  • Arm / diagnostic imaging
  • Back / diagnostic imaging
  • Diabetes Complications
  • Exudates and Transudates / diagnostic imaging
  • Fascia / diagnostic imaging
  • Fasciitis, Necrotizing / complications
  • Fasciitis, Necrotizing / diagnostic imaging*
  • Fasciitis, Necrotizing / pathology
  • Fasciitis, Necrotizing / therapy
  • Female
  • Gases
  • Genital Diseases, Male / diagnostic imaging
  • Humans
  • Kidney Failure, Chronic / complications
  • Leg / diagnostic imaging
  • Male
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Neck / diagnostic imaging
  • Perineum / diagnostic imaging
  • Radiography, Abdominal
  • Retrospective Studies
  • Scrotum / diagnostic imaging
  • Substance-Related Disorders / complications
  • Survival Rate
  • Tomography, X-Ray Computed*
  • Treatment Outcome

Substances

  • Gases