What is the role of radiography in the diagnosis of necrotizing fasciitis?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Plain radiographs, often obtained to detect soft-tissue gas that is sometimes present in polymicrobial or clostridial necrotizing fasciitis, are of no value in the diagnosis of necrotizing infections. [69] Indeed, nondiagnostic plain radiographs may even hinder the diagnosis of necrotizing infection. [60] In their study of 29 patients with necrotizing soft tissue infections, Lille et al reported that nondiagnostic radiographs correlate with a delay in operative intervention and consequent increased morbidity and mortality. [70]

The presence of subcutaneous gas in a radiograph does not necessarily indicate a clostridial infection, as Escherichia coli, Peptostreptococcus species, and Bacteroides species may produce gas under appropriate conditions. Misleading subcutaneous gas can also result from the undermining of tissue planes during surgical debridement. Perforations of the esophagus, the respiratory tract, or the GI tract related to endoscopy or chest tube insertion can result in the radiographic appearance of gas.

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