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Necrotizing Fasciitis (cont.)

Necrotizing Fasciitis Diagnosis

The diagnosis of necrotizing fasciitis is often presumptively made initially based on the patient's history and physical examination findings. Though there are several laboratory tests and imaging studies that may assist in making the diagnosis of necrotizing fasciitis, immediate results may not be readily available. Therefore, a high index of suspicion in any patient with symptoms or signs suggestive of necrotizing fasciitis should prompt immediate consultation with a surgeon in order to expedite management.

  • Laboratory testing will include various blood tests such as a complete blood count (CBC), which may reveal an elevated white blood cell count (WBC). Electrolyte panels, blood cultures, and other blood tests are also generally obtained. However, the results of these blood tests cannot be solely relied upon to make an immediate diagnosis.
  • Imaging studies such a CT scanning, MRI, and ultrasound have all been used successfully to identify cases of necrotizing fasciitis. They may be used when signs are equivocal or the diagnosis is in doubt. These modalities may help identify areas of fluid collections, inflammation and gas within the soft tissue, in addition to helping delineate the extent of the infection. Although occasionally plain radiographs (X-rays) may demonstrate gas in the soft tissue, they are considered less useful and of little value. Obtaining imaging studies should not delay definitive treatment in those cases highly suggestive of necrotizing fasciitis.
  • Tissue culture, tissue biopsy, and Gram stain results can help definitively identify the organism(s) responsible for the infection, and this can help guide appropriate antibiotic therapy.
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