Journal of Ultrasound in Medicine, Vol 18, Issue 4 277-281, Copyright © 1999 by American Institute of Ultrasound in Medicine
Diagnosis of necrotizing fasciitis in children
H. C. Chao, M. S. Kong and T. Y. Lin
Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan, Republic of China.
Necrotizing fasciitis is a rare but progressive soft tissue infection. This
condition is difficult to recognize in the early phase, when it is often
confused with cellulitis. We report the cases of four children with
necrotizing fasciitis. The initial presentation in these cases was
cellulitis. Fever and soft tissue swelling occurred within 24 h and
spreading erythema within 4 to 12 h. Radiologic studies of the lesions
showed soft tissue thickening. Ultrasonography of the lesions demonstrated
distorted, thickened fascia with fluid accumulation. Well-defined,
loculated abscesses were demonstrated in two cases. Although typical dusky
skin and purplish patches were not found in our cases, necrotizing
fasciitis was strongly suspected on the basis of the clinical course and
sonographic findings. Ultrasonography also was used as a guide for
aspiration of pus. Gram-stained smears and bacterial cultures yielded the
pathogens. The choice of antibiotic therapy was made on the results of
smears and culture. All patients survived after immediate surgical
debridement, intensive antibiotic therapy, and aggressive wound care. In
conclusion, ultrasonography provides a rapid and valuable diagnostic
modality for necrotizing fasciitis. The pus obtained through
sonographically guided aspiration for bacterial culture can allow
identification of the pathogenic organisms.
