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Necrotizing Fasciitis
Lauren M. Ladd, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Necrotizing fasciitis (NF): aggressive soft tissue infection of subcutis and deep fascia by toxin-producing organisms that spread rapidly and cause necrosis/liquefaction of muscle and fat
              • Fournier gangrene: necrotizing fasciitis of perineum
              • Ludwig angina: NF in submandibular region
              • Deep fascia: peripheral deep fascia invests surface of muscles; intermuscular (IM) deep fascia between muscles
              • Superficial fascia: within subcutis, about halfway from skin to muscles

            IMAGING

            • General Features

              • Radiograph Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Reporting Tips

                                      Selected References

                                      1. Alaia EF et al: MRI nomenclature for musculoskeletal infection. Skeletal Radiol. 50(12):2319-47, 2021
                                      2. Kim MC et al: Utility of magnetic resonance imaging for differentiating necrotizing fasciitis from severe cellulitis: a magnetic resonance indicator for necrotizing fasciitis (MRINEC) Algorithm. J Clin Med. 9(9), 2020
                                      3. Palmer W et al: Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 49(Suppl 1):1-33, 2020
                                      4. Paz Maya S et al: Necrotizing fasciitis: an urgent diagnosis. Skeletal Radiol. 43(5):577-89, 2014
                                      5. Kim KT et al: Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 259(3):816-24, 2011
                                      6. Edlich RF et al: Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 39(2):261-5, 2010
                                      7. Turecki MB et al: Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 39(10):957-71, 2010
                                      8. Seok JH et al: Necrotizing fasciitis versus pyomyositis: discrimination with using MR imaging. Korean J Radiol. 10(2):121-8, 2009
                                      9. Yu JS et al: MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. 16(4):267-76, 2009
                                      10. Levenson RB et al: Fournier gangrene: role of imaging. Radiographics. 28(2):519-28, 2008
                                      11. Fayad LM et al: Musculoskeletal infection: role of CT in the emergency department. Radiographics. 27(6):1723-36, 2007
                                      12. Fugitt JB et al: Necrotizing fasciitis. Radiographics. 24(5):1472-6, 2004
                                      13. Jallali N: Necrotising fasciitis: its aetiology, diagnosis and management. J Wound Care. 12(8):297-300, 2003
                                      14. Arslan A et al: Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis. Eur J Radiol. 36(3):139-43, 2000
                                      15. Brothers TE et al: Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. 187(4):416-21, 1998
                                      16. Schmid MR et al: Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol. 170(3):615-20, 1998
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Definitions

                                                  • Necrotizing fasciitis (NF): aggressive soft tissue infection of subcutis and deep fascia by toxin-producing organisms that spread rapidly and cause necrosis/liquefaction of muscle and fat
                                                  • Fournier gangrene: necrotizing fasciitis of perineum
                                                  • Ludwig angina: NF in submandibular region
                                                  • Deep fascia: peripheral deep fascia invests surface of muscles; intermuscular (IM) deep fascia between muscles
                                                  • Superficial fascia: within subcutis, about halfway from skin to muscles

                                                IMAGING

                                                • General Features

                                                  • Radiograph Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Alaia EF et al: MRI nomenclature for musculoskeletal infection. Skeletal Radiol. 50(12):2319-47, 2021
                                                                          2. Kim MC et al: Utility of magnetic resonance imaging for differentiating necrotizing fasciitis from severe cellulitis: a magnetic resonance indicator for necrotizing fasciitis (MRINEC) Algorithm. J Clin Med. 9(9), 2020
                                                                          3. Palmer W et al: Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 49(Suppl 1):1-33, 2020
                                                                          4. Paz Maya S et al: Necrotizing fasciitis: an urgent diagnosis. Skeletal Radiol. 43(5):577-89, 2014
                                                                          5. Kim KT et al: Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 259(3):816-24, 2011
                                                                          6. Edlich RF et al: Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 39(2):261-5, 2010
                                                                          7. Turecki MB et al: Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 39(10):957-71, 2010
                                                                          8. Seok JH et al: Necrotizing fasciitis versus pyomyositis: discrimination with using MR imaging. Korean J Radiol. 10(2):121-8, 2009
                                                                          9. Yu JS et al: MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. 16(4):267-76, 2009
                                                                          10. Levenson RB et al: Fournier gangrene: role of imaging. Radiographics. 28(2):519-28, 2008
                                                                          11. Fayad LM et al: Musculoskeletal infection: role of CT in the emergency department. Radiographics. 27(6):1723-36, 2007
                                                                          12. Fugitt JB et al: Necrotizing fasciitis. Radiographics. 24(5):1472-6, 2004
                                                                          13. Jallali N: Necrotising fasciitis: its aetiology, diagnosis and management. J Wound Care. 12(8):297-300, 2003
                                                                          14. Arslan A et al: Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis. Eur J Radiol. 36(3):139-43, 2000
                                                                          15. Brothers TE et al: Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. 187(4):416-21, 1998
                                                                          16. Schmid MR et al: Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol. 170(3):615-20, 1998