Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management

Radiology. 1997 Feb;202(2):471-6. doi: 10.1148/radiology.202.2.9015076.


Purpose: To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management.

Materials and 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Fasciitis, Necrotizing / complications
  • Fasciitis, Necrotizing / diagnostic imaging*
  • Fasciitis, Necrotizing / therapy
  • Female
  • Head* / diagnostic imaging
  • Humans
  • Infant, Newborn
  • Male
  • Middle Aged
  • Neck* / diagnostic imaging
  • Soft Tissue Infections / complications
  • Soft Tissue Infections / diagnostic imaging
  • Soft Tissue Infections / therapy
  • Tomography, X-Ray Computed*