D.A. DOROSHENKO¹, S.V. GORYUNOV², I.A. CHIZH², O.E. PSHENNOVA²

 ¹N.I. Pirogov Russian National Research Medical University, Moscow

²City Clinical Hospital No. 15 named after O.M. Filatov, Moscow

 Contact details:

Chizh I.A. — radiologist of the Department of Radiation and Functional Diagnostic Methods

Address: 23 Veshnyakovskaya St., Moscow, Russian Federation, 111539, tel.: +7-919-721-81-96, e-mail: chizhirin@yandex.ru

The purpose — to demonstrate the capabilities of computed tomography and ultrasound in the diagnosis and treatment planning of a patient with a rare case of necrotizing fasciitis.

Material and methods. A clinical observation of a 57-year-old patient K. with complaints of pain in the area of the right foot, reddening of the skin on the right foot is presented. T — 37.2 ºC. To determine the nature of the revealed changes, the patient was referred to the Department of Radiation and Functional Diagnostic Methods for soft tissue ultrasound and computed tomography (CT) of the vessels of the lower extremities to assess the lesion and plan surgical treatment.

Results. After an ultrasound of the soft tissues of the right leg posterior surface, around the gastrocnemius muscle, an inhomogeneous liquid rim (an echo picture of fasciitis), soft tissue edema was visualized. CT of the lower extremities vessels showed a decrease in blood flow in the lower leg arteries, infiltration and a moderate amount of gas in the soft tissues of n/3 of the lower leg and foot.

Discussion. Necrotizing fasciitis (fasciitis necrotisans) is a representative of a large group of surgical infections of soft tissues, the morphological basis of which is progressive necrosis of the superficial fascia (fascia superficialis) and subcutaneous adipose tissue, and the clinical course is particularly severe and is accompanied by high mortality. NF is an emergency surgical situation. Early and accurate diagnosis is critical to provide the necessary aggressive treatment.

Conclusion. This clinical observation demonstrates the importance of conducting a study using computed tomography and ultrasound in patients with necrotizing fasciitis for the earliest possible diagnosis and immediate surgical treatment, supported by effective antibiotic therapy.

Key words: computed tomography, CT scan, necrotizing fasciitis, soft tissue infection.

REFERENCES

1. Nikolov V.V. Necrotizing fasciitis is an urgent condition in medicine. Intensivnaya terapiya, 2015, no. 2 (in Russ.).
2. Bellapianta J.M., Ljungquist K. Journal of the American Academy of Orthopaedic Surgeons, 2009, vol. 17 (3), pp. 174–182.
3. Wong C., Chang H., Pasupathy S. et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am, 2003, vol. 85A, pp. 1454–1460.
4. Markowitz M., Kwan S., Matzon J.L. Household Transmission of Group A Streptococcus Necrotizing Fasciitis. Global Research & Reviews, 2022, vol. 6 (8), pp. e21.00171.
5. William A., Kaur R., Rawat D. et al. Necrotizing fasciitis in neonate by Lichtheimiaramosa: a case study. Access Microbiol, 2022, vol. 4, p. 000327.
6. Zhang Z., Liu P., Yang B. et al. Necrotizing fasciitis caused by diabetic foot. Int J Infect Dis, 2020, vol. 14, pp. 316–327.
7. Hakkarainen T.W., Kopari N.M., Pham Tam N. et al. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Science Direct, 2014, vol. 51 (8), pp. 344–362.
8. Pelletier J., Gottlieb M., Long B., Perkins J.C.Jr. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. Science Direct, 2022, vol. 62 (4), pp. 480–491.
9. Bellapianta J.M., Ljungquist K., Tobin E., Uhl R. Necrotizing fasciitis, 2009, vol. 17 (3), pp. 174–182.
10. Grinev M.V., Grinev K.M. Nekrotiziruyushchiy fastsiit [Necrotizing fasciitis]. Gippokrat, 2008. 118 p.
11. Hua C., Bosc R., Sbidian E. et al. Interventions for necrotizing soft tissue infections in adults — Hua, C. Cochrane Library, 2018.
12. Marks A., Patel D., Sundaram T. et al. Ultrasound for the diagnosis of necrotizing fasciitis: A systematic review of the literature. Science Direct, 2023, vol. 65, pp. 31–35.
13. Lahham Sh., Shniter I., Desai M. et al. Point of Care Ultrasound in the Diagnosis of Necrotizing Fasciitis. Science Direct, 2022, vol. 51, pp. 397–400.