Titre
Necrotizing fasciitis: contribution and limitations of diagnostic imaging.
Type
synthèse (review)
Institution
Externe
Périodique
Auteur(s)
Malghem, J.
Auteure/Auteur
Lecouvet, F.E.
Auteure/Auteur
Omoumi, P.
Auteure/Auteur
Maldague, B.E.
Auteure/Auteur
Vande Berg, B.C.
Auteure/Auteur
Liens vers les personnes
ISSN
1778-7254
Statut éditorial
Publié
Date de publication
2013
Volume
80
Numéro
2
Première page
146
Dernière page/numéro d’article
154
Langue
anglais
Notes
Publication types: Journal Article ; Review Publication Status: ppublish. PDF type: review
Résumé
Necrotizing fasciitis is a rare, rapidly spreading, deep-seated infection causing thrombosis of the blood vessels located in the fascia. Necrotizing fasciitis is a surgical emergency. The diagnosis typically relies on clinical findings of severe sepsis and intense pain, although subacute forms may be difficult to recognize. Imaging studies can help to differentiate necrotizing fasciitis from infections located more superficially (dermohypodermitis). The presence of gas within the necrotized fasciae is characteristic but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, which can be visualized using computed tomography and, above all, magnetic resonance imaging (high signal on contrast-enhanced T1 images and T2 images, best seen with fat saturation). These findings lack specificity, as they can be seen in non-necrotizing fasciitis and even in non-inflammatory conditions. Signs that support a diagnosis of necrotizing fasciitis include extensive involvement of the deep intermuscular fascias (high sensitivity but low specificity), thickening to more than 3mm, and partial or complete absence on post-gadolinium images of signal enhancement of the thickened fasciae (fairly high sensitivity and specificity). Ultrasonography is not recommended in adults, as the infiltration of the hypodermis blocks ultrasound transmission. Thus, imaging studies in patients with necrotizing fasciitis may be challenging to interpret. Although imaging may help to confirm deep tissue involvement and to evaluate lesion spread, it should never delay emergency surgical treatment in patients with established necrotizing fasciitis.
PID Serval
serval:BIB_B8B63534456B
PMID
Date de création
2013-12-03T09:12:28.270Z
Date de création dans IRIS
2025-05-20T22:42:52Z