Pneumatosis in cervical fascial space and necrotizing fasciitis of neck

Abstract

Backgroud

Pneumatosis in the cervical fascial space is a common imaging manifestation of cervical necrotizing fasciitis. At present, although there are some literature reports on pneumatosis in the cervical necrotizing fasciitis, there are few comparative reports.

Objective

To compare the imaging findings of necrotizing fasciitis of the neck and other cervical space infections, and explore the relationship between pneumatosis in cervical fascial space and necrotizing fasciitis of the neck.

Methods

A retrospective study was conducted on 56 cases of cervical fascia space infection in our department from May 2015 to March 2021, including 22 cases of necrotizing fasciitis and 34 cases of non-necrotizing fasciitis. 22 cases underwent incision, debridement and catheter drainage in the necrotizing fasciitis group. 26 cases underwent incision, debridement and catheter drainage, and 8 cases underwent ultrasound-guided puncture biopsy and catheter drainage in the non-necrotizing fasciitis group. All cases were confirmed by operation or pathological biopsy and took purulent secretions for bacterial culture and drug sensitivity test during or after operation. All cases were examined by neck CT or MRI before operation. The previous history of surgical incision or puncture and the rupture of cervical space infection were excluded.

Results

In 22 cases of necrotizing fasciitis, there were 19 cases had air accumulation in the fascial space (86.4%); In 34 cases of non necrotizing fasciitis, 2 cases had air accumulation in the fascial space (5.9%). There was significant difference between the two groups (χ² = 36.9141, p < .01). Bacterial culture results were positive in 18 (81.8%) patients in the necrotizing fasciitis group. In the non necrotizing fasciitis group, 12 (35.3%) patients had positive bacterial culture results. There was significant difference in the positive rate of bacterial culture between the two groups (χ² = 11.6239, p < .01). Except one death in necrotizing fasciitis group, all other patients were cured. There was no recurrence after follow-up for 3–6 months.

Conclusions and Significance

The pneumatosis of necrotizing fasciitis in the neck is dramatically more than that of other infectious diseases. It is suggested that pneumatosis in cervical fascial space is of great significance in the diagnosis of cervical necrosis, the gas production of bacteria may be closely related to the pathogenesis and development of necrotizing fasciitis of the neck, and early measures to block the generation and dissemination of gas is of great significance for treatment.

Chinese Abstract

背景：颈筋膜间隙积气是颈椎坏死性筋膜炎的常见的影像学表现。目前, 虽然国内也有一些关于颈坏死性筋膜炎积气的文献报道, 比较性报道较少。

目的：比较颈部坏死性筋膜炎与其它颈椎炎症的影像学表现。探讨颈筋膜间隙积气与颈部坏死性筋膜炎的关系。

方法：对我院2015年5月至2021年3月期间收治的56例颈筋膜间隙感染病例进行回顾性研究, 包括坏死性筋膜炎22例, 非坏死性筋膜炎34例。 坏死性筋膜炎组的22个病例均行切开清创置管引流术。 非坏死性筋膜炎组中, 26例行切开清创置管引流术, 8例接受超声引导下穿刺活检和导管引流。 所有病例均经手术或病理活检确诊, 并在术中或术后取脓液分泌物进行细菌培养和药敏试验。 所有病例均术前行颈部CT或MRI检查。 既往手术切口或穿刺史及颈间隙感染破裂排除在外。

结果：22例坏死性筋膜炎中, 19例出现筋膜间隙积气 (86.4%)； 34例非坏死性筋膜炎中, 2例出现筋膜间隙积气(5.9%)。两组之间存在显著性差异(χ2 = 36.9141, p<.01)。 坏死性筋膜炎组中有 18 名患者（81.8%）细菌培养结果呈阳性。 在非坏死筋膜炎组中12例（35.3%）患者细菌培养结果阳性。两组间细菌培养阳性率有显著差异(χ2 = 11.6239, p<.01)。坏死性筋膜炎组中除了一例死亡, 其余均治愈。随访 3-6 个月之后没有复发。

结论与意义：颈部坏死性筋膜炎积气明显多于其它感染性疾病。我们认为, 颈筋膜间隙积气对于诊断颈部坏死有着重要意义。细菌产气可能与颈部坏死性筋膜炎的发病、发展密切相关。及早采取措施阻断气体的产生和扩散对治疗有着重要意义。

Keywords:

• Necrotizing fasciitis
• neck
• infection
• aerogenic bacteria
• pneumatosis
• fascia space

Disclosure statement

No potential conflict of interest was reported by the author(s).