Markeson Daniel, Nijjar Reet, Evgeniou Evgenios, Kulkarni Mahendra
Department of Plastic Surgery, Wexham Park Hospital, Slough, Berkshire, UK.
BMJ Case Rep. 2012 Oct 6;2012:bcr-2012-006659. doi: 10.1136/bcr-2012-006659.
Necrotising fasciitis (NF) is a rapidly progressive soft tissue infection involving necrosis of subcutaneous tissues. Early surgical intervention reduces mortality, but initial clinical findings are often non-specific and can delay the diagnosis. An 80-year-old patient, presented to our emergency department with pain in her left hip and mild bruising following a fall. An x-ray, requested to investigate a possible hip fracture, in fact demonstrated air in the subcutaneous tissues. She rapidly deteriorated and soon developed blood-filled blisters, crepitus and fixed staining of the skin. She underwent urgent debridement of involved tissues in theatre confirming the diagnosis of NF. The presence of subcutaneous emphysema on plain radiograph as in this case, is extremely specific to the diagnosis of NF. Although other imaging modalities can aid diagnosis these remain as an adjunct rather than a definitive diagnostic tool and should not delay surgical intervention based on clinical findings.
坏死性筋膜炎（NF）是一种迅速进展的软组织感染，累及皮下组织坏死。早期手术干预可降低死亡率，但最初的临床表现往往不具特异性，可能会延迟诊断。一名80岁的患者因跌倒后左髋部疼痛和轻度瘀伤前来我院急诊科就诊。为排查可能的髋部骨折而进行的X线检查实际上显示皮下组织中有气体。她病情迅速恶化，很快出现充满血液的水疱、捻发音和皮肤固定性变色。她在手术室接受了受累组织的紧急清创术，确诊为坏死性筋膜炎。如本例平片上出现皮下气肿，对坏死性筋膜炎的诊断具有极高的特异性。尽管其他影像学检查方法有助于诊断，但它们仍只是辅助手段而非确定性诊断工具，不应基于临床发现而延迟手术干预。
