Case: Necrotizing Fasciitis
HIDEInteractive Transcript
0:01
Let's look at this patient who had left sided neck pain, fever,
0:05
and there were areas of breakdown in the skin.
0:08
We start off superiorly looking at the brain.
0:11
The brain tissue looks fine.
0:13
The vessels of the circle of Willis look fine.
0:16
The orbit got a little bit of enlargement
0:19
of the optic nerve sheath complex.
0:21
And then we see this area of air in the temporalis muscle
0:26
of the masticator space. Let's follow that air downward.
0:30
So we see new air here at the pterygoid muscle, as well
0:34
as at the coronoid process of the left mandible.
0:38
In the left side of the neck,
0:39
we have air in the parapharyngeal space,
0:42
anterior to the carotid sheath,
0:44
and there is mass effect displacing the airway from
0:48
left to right. Continuing in the left side of the neck,
0:51
we also see involvement of the buccal space, as well as the area
0:56
around the parotid tissue, which is coursing along
1:00
the expected location of Stensen's duct.
1:04
The left side of the neck continues to show areas of
1:08
abnormality in the parapharyngeal space with all this
1:11
air collection, again, airway displaced medially.
1:15
And here we have air in the retropharyngeal space,
1:18
a collection of purulent material coming into the
1:24
peritonsillar region, and then into the floor of the mouth,
1:29
submandibular space, submental space,
1:32
and we're also seeing a trek even to the posterior triangle
1:37
and the supraclavicular fossa, and then from there, into the
1:41
visceral space of the head and neck
1:44
structures and strap muscles.
1:46
Here you have just beads of air along the clavicle in the
1:51
supraclavicular and infraclavicular space, and
1:54
then even towards the axilla.
1:56
Well, clearly,
1:57
as you hear me describe this, this is transpatial.
2:00
It's going across the fascia of the masticator space,
2:06
the parotid space, the parapharyngeal space,
2:08
the retropharyngeal space, the visceral space,
2:13
as well as the submandibular and submental space,
2:17
and then into the supraclavicular
2:19
fossa and even into the axilla.
2:22
This is destroying the fascia that normally would separate an
2:27
infectious process into one of the spaces and confine it.
2:30
It's just eating right through the fascia.
2:33
This is known as necrotizing fasciitis,
2:36
a very virulent infection that is very hard to eradicate,
2:41
requires intravenous antibiotic and often requires debridement
2:45
of dead tissue that is occurring in the neck.
2:49
At this point, with this... as diffuse as this is,
2:52
this patient is unlikely to survive this infection.
2:57
You also want to look and make sure that you don't see
3:00
areas where there has been breakdown in the skin surface.
3:04
Because that could be a secondary infection of staph.
3:08
epididymis or staph. aureus, extending into the area
3:11
where there already is an aggressive infection.
3:14
So just a horrifying infection,
3:17
necrotizing fasciitis.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
© 2025 Medality. All Rights Reserved.