title: Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management.
abstract: OBJECTIVE
  To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management.
  
  
  METHODS
  Fourteen patients with surgically proved necrotizing fasciitis of the extracranial head and neck were examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after initial treatment were analyzed retrospectively.
  
  
  RESULTS
  Constant CT features of necrotizing fasciitis were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck compartments. Inconstant CT features included gas collections, mediastinitis, and pleural or pericardial effusions. All patients underwent extensive surgical debridement. Follow-up CT scans in 11 patients revealed clinically unsuspected progression of the inflammatory process in previously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and medical treatment.
  
  
  CONCLUSIONS
  Early recognition of necrotizing fasciitis with CT enables appropriate surgical treatment. CT may also be a useful guide in further patient treatment after initial surgical debridement.
authors.affiliation: Department of Radiology, University Hospital of Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Becker
authors.forename: P
authors.initials: P
authors.lastname: Zbären
authors.forename: R
authors.initials: R
authors.lastname: Hermans
authors.forename: C D
authors.initials: CD
authors.lastname: Becker
authors.forename: F
authors.initials: F
authors.lastname: Marchal
authors.forename: A M
authors.initials: AM
authors.lastname: Kurt
authors.forename: S
authors.initials: S
authors.lastname: Marré
authors.forename: D A
authors.initials: DA
authors.lastname: Rüfenacht
authors.forename: F
authors.initials: F
authors.lastname: Terrier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D018461:Soft Tissue Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed