Images in Emergency Medicine
Article Outline
Figure 1.
Radiologic image of leg. Note the appearance of gas in the soft tissues.
Figure 2.
Clinical picture of patient. Used with permission of Ekaterini Anesti, MD, FRCSEd, Pinderfields General Hospital, Wakefield, UK.
[Ann Emerg Med. 2007;50:14.]
A 93-year-old woman presented to the Accident and Emergency Department with sudden onset of erythema, swelling, and tenderness of her right lower leg. Within a few hours, she developed above-knee spreading cellulitis, discoloration, bullae formation, and skin necrosis, with a small amount of crepitus on palpation. The patient was toxic out of proportion to the temperature increase, with signs of tachycardia and hypotension. She underwent extensive debridement and above-knee amputation but died from multiorgan failure as a result of toxic shock the same day.
Diagnosis
Gas gangrene. Radiographs of the leg confirmed the diagnosis of gas gangrene, with air in the soft tissues, extending above the knee. Gas gangrene is a rare but rapidly progressive, life-threatening infection of the subcutaneous tissue, necrosis of fat, and fascia, often with sparing of the underlying muscles. It was first described by Hippocrates in the fifth century bc.1 It can occur idiopathically and is frequently a polymicrobial infection that sometimes develops in the absence of streptococci.2 Mortality ranges from 33% to 73% and is correlated to patient medical history, comorbid conditions, and delayed diagnosis.3 Early recognition, aggressive resuscitation, and prompt surgical debridement of all involved layers of tissue are required to combat this highly lethal condition.4
References
- . Hippocrates on necrotising fascitis. Lancet. 1994;344:556
- . Gas gangrene and related infection: classification, clinical features and aetiology, management and mortality: a report of 88 cases. Br J Surg. 1977;64:104–112
- Necrotising fascitis: a dramatic surgical emergency. Eur J Emerg Med. 2004;11:44–48
- Necrotising fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;68:109–116
For the diagnosis and teaching points, see page 33.To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com
PII: S0196-0644(06)02620-5
doi:10.1016/j.annemergmed.2006.11.027
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
