CT diagnosis of necrotizing fasciitis: Spectrum of CT findings

Necrotizing fasciitis is a life-threatening soft tissue infection involving the superficial fascia and subcutaneous fat that requires aggressive, prompt surgical debridement. The early diagnosis of necrotizing fasciitis is often difficult as it may present in an elusive fashion with relatively minor physical findings. Additionally, the clinical findings often overlap with those of relatively benign conditions such as cellulitis which require conservative management. Historically, plain film and nuclear medicine studies have been used in the diagnosis and management of musculoskeletal inflammatory processes. However, with the advent of cross-sectional imaging modalities, CT has become crucial to the diagnosis and evaluation of soft tissue infections. Few publications exist that describe the CT characteristics of necrotizing fasciitis involving the chest, abdomen, and extremities, and the role of CT in the diagnosis and treatment of these life-threatening infections. The purpose of this paper is to show the CT findings in necrotizing fasciitis and associated complications. We will provide examples of necrotizing fasciitis arising in a postoperative bed as well as the CT appearance following aggressive debridement, together with descriptive information that may improve the early detection of this entity.