The role of point-of-care ultrasound in the diagnosis and management of necrotizing soft tissue infections

Abstract

Background: Necrotizing soft tissue infections are associated with high morbidity and mortality, even when the correct treatment is initiated. The diagnosis of these conditions is hard and the most sensitive methods are time-consuming, expensive and not readily available. Point-of-care ultrasound can complement clinical evaluation to increase the diagnostic accuracy. Case presentation: We bring a case of a woman, without comorbidities, who presented to the emergency department with signs of soft tissue infection. Bedside ultrasound showed subcutaneous tissue thickening, with fluid accumulation, and subcutaneous gas in the affected area. Based on the clinical suspicion and the ultrasound findings, the patient underwent prompt medical treatment and surgical debridement. Conclusions: This case shows the utility of bedside ultrasound for the decision-making process in a disease where an early diagnosis is important. This information should always be used together with the clinical judgement, as it has a relative low sensitivity.

Type II necrotizing fasciitis

“…In addition, it provides information to help distinguish between simple and necrotizing soft tissue infections 1 , but in early stages of presentation it may not show obvious changes. Findings congruent with type II NF are the thickening of the subcutaneous tissue and the appearance of hypoechogenic areas corresponding to fluid accumulation along the deep fascia 1,19,20 . Increased echogenicity of fat may and the doctor's are more important than the total score obtained.…”

WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections

“…US has the advantage of being rapidly performed at the bedside and may help differentiate simple cellulitis from NSTIs [ 45 ], but again is not considered highly accurate nor definitive in most settings. Point-of-care US (POCUS) can improve diagnose accuracy for NSTI when used in combination with clinical evaluation as it is increasingly available, fast and can be performed at the bedside [ 59 ]. The main ultrasound findings are summarized in loss of the normal tissue architecture to a “cobblestone” appearance, with irregularity and thickening of the fascia, abnormal fluid collections along the fascia, seen as hypoechogenic zones, and, in more advanced cases, the presence subcutaneous air, defined by hyperechogenic foci with a posterior dirty acoustic shadowing.…”

Effectiveness of fire needle combining with moist healing dressing to promote the growth of granulation tissue in chronic wounds: A case report

“…The treatment principles of chronic wounds mainly include improving the body’s overall state, improving the blood supply to the wound, reducing the inflammatory response, promoting the epithelialization of wound skin, and promoting granulation tissue growth through pharmacological or nonpharmacological therapies [ 8 , 9 ]. At present, studies have reported some therapies for the treatment of chronic wounds, such as ultrasound debridement [ 10 ], biological debridement [ 11 ], silver dressing [ 12 ], negative-pressure wound therapy [ 13 ], platelet-rich plasma [ 14 ], and growth factor therapy [ 15 ]. Due to the lack of clinical evidence, these wound treatment methods currently fail to show obvious advantages.…”