Using Point-of-Care Ultrasound to Expedite Diagnosis of Necrotizing Fasciitis: A Case Report

Romero Kupai, MD, Ashkan Morim, MD, Lucas Friedman, MD and Eva Tovar Hirashima, MD, MPH

doi:https://doi.org/10.21980/J85051

Using Point-of-Care Ultrasound to Expedite Diagnosis of Necrotizing Fasciitis: A Case Report

Romero Kupai, MD^*, Ashkan Morim, MD^*, Lucas Friedman, MD^{*^} and Eva Tovar Hirashima, MD, MPH^{*^}

^*HCA Healthcare, Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA

^{^}University of California Riverside, School of Medicine, Riverside, CA

Correspondence should be addressed to Romero Kupai, MD at romero.kupai@hcahealthcare.com

DOI: https://doi.org/10.21980/J85051 Issue 6:2

Infectious Disease Visual EM

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ABSTRACT:

It is vital that all emergency medicine physicians (EP) are able to perform and evaluate point-of-care ultrasound (POCUS) images when a patient’s presentation is concerning for necrotizing fasciitis (NF).

We present a case of a 69-year-old man who had initially presented to an outside hospital with testicular edema and difficulty urinating. Consultative ultrasound was interpreted as a hydrocele and bilateral scrotal pearls but failed to identify the sonographic hallmarks of NF (subcutaneous thickening, free fluid, and subcutaneous air). Computed tomography (CT) performed several hours later re-demonstrated free air and fascial thickening in the scrotum prompting transfer to our hospital for a higher level of care. Upon arrival to our emergency department (ED) POCUS showed extensive free air with shadowing, thickened subcutaneous tissue, and fluid collections. The patient was immediately evaluated by general surgery and urology, who took him to the operating room for debridement.

This case highlights the challenges EP face when assessing patients with NF. Early-on, clinical findings can be subtle and easily missed. POCUS can aid in the diagnosis of this time-dependent disease process. Therefore, it is paramount that EPs look for and recognize characteristic sonographic findings present in NF to improve the accuracy and timeliness of the diagnosis.