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Emergency ultrasonography for the early diagnosis of necrotizing fasciitis: a case series from the ED

Published:January 23, 2013DOI:https://doi.org/10.1016/j.ajem.2012.09.026
      Necrotizing fasciitis is a rapidly progressing and life-threatening bacterial infection of deep subcutaneous tissues. Prompt diagnosis and surgical intervention decrease morbidity and improve patient survival [
      • Anaya D.A.
      • McMahon K.
      • Nathens A.
      • et al.
      Predictors of mortality and limb loss in necrotizing soft tissue infections.
      ]. A paucity of physical examination findings in early disease hinders timely diagnosis contributing to a high mortality rate of 25% to 30% [
      • Sarani B.
      • Strong M.
      • Pascual J.
      • et al.
      Necrotizing fasciitis: current concepts and review of literature.
      ]. Emergency department physicians rely on clinical suspicion to make the diagnosis in critically ill patients as advanced imaging modalities such as computed tomography or magnetic resonance imaging may result in an unacceptable delay to surgical intervention. Emergency ultrasound is a quick and convenient imaging modality that can expedite the diagnosis of necrotizing fasciitis in concerning soft tissue infections. We report 3 confirmed cases of necrotizing fasciitis in which emergency provider performed emergency ultrasound identified findings highly suggestive of necrotizing fasciitis that included fluid tracking along the fascial plane, diffuse fascial thickening, irregularity of the fascia, and the presence of subcutaneous air leading to expedited diagnosis and surgical intervention.
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