Table 3.
Summary of case reports and case series
| References | Age (years) | Comorbidity | Ultrasound probe | Affected site | Ultrasonographic findings | Treatment | Outcome | Remarks |
|---|---|---|---|---|---|---|---|---|
| Hanif 2008 [15] | 34 | Overweight | Linear probe | Left breast |
Subcutaneous thickening (diffuse edema of the glandular tissue of the breast) Air Fascia fluid |
I.V. Antibiotics Mastectomy with repeated surgical debridement | Recovered | Group A streptococcus infection |
| Hosek 2009 [16] | 32 | Depression and Opiate withdrawal | N/A | Left forearm pain | Air | I.V. Antibiotics Left forearm fasciotomy with debridement | Recovered | – |
| Wronski 2011 [17] | 62 | Diabetes mellitus admitted for G.I. bleeding | Linear probe | Right forearm, 5 cm above venipuncture site |
Subcutaneous thickening, Air Fascial fluid (extending beyond the margins of grossly changed skin) |
I.V. Antibiotics; Urgent surgical debridement | N/A | – |
| Testa 2013 [18] | 65 | Stage 4 colorectal cancer | Linear probe | Left calf |
Subcutaneous thickening Fascial fluid Hypo-anechoic small area with blurred contours and marked edge shadowing (due to fat necrosis and suppurative infiltration, with posterior shadowing) |
I.V. Antibiotics Surgical debridement Chemical amputation with the antiseptic alcohol solution | Discharged to family care | E. coli infection |
| Castleberg 2014 [10] | 44 | Morbid Obesity | N/A | Left groin and inner thigh |
Subcutaneous thickening Air Fascial fluid |
I.V. Antibiotics; Surgical debridement; Vacuum-assisted closure | Fully ambulatory and discharged home on postoperative day 28 | Requires five days of ICU care for septic shock |
| Bernardi 2014 [19] | 68 | Nil | Linear probe | Left knee | Air | I.V. Antibiotics, fasciotomy, surgical debridement, and amputation with disarticulation of the left lower limb | Succumb to illness on day 13 of admission | – |
| Kehrl 2014 [8] | 54 | Type 2 Diabetes, peripheral neuropathy, hypertension, hyperlipidemia, tobacco abuse, obesity, depression, previous MRSA | Linear probe | Right foot and lower leg |
Diffuse fascial thickening Irregularity of fascia fascial fluid fluid collection around extensor tendons |
I.V. Antibiotics, incision, and debridement, admitted to ICU requiring ventilator and vasopressors | Recovered well and was discharged on day 34 | Streptococcus Pyogenes infection |
| Thom 2016 [20] | 78 | Diabetes and peripheral arterial disease | Linear probe | Right leg |
Subcutaneous thickening Air |
I.V. Antibiotics, Emergency amputation | N/A | – |
| Clark 2017 [6] | 53 | Hypertension and Tachycardia | Linear probe | Left thigh |
Subcutaneous thickening Air Fascial fluid |
I.V. Antibiotics, Extensive debridement | N/A | Transferred to another facility |
| Alonso 2017 [21] | 60 | N/A | N/A | Left thigh |
Subcutaneous thickening Air, Fascial fluid |
I.V. Antibiotics, Intensive care, and high dose of vasopressor | Patients succumb to illness 24 h later | – |
| Martínez-Doménech 2019 [22] | 50 | N/a | N/A | Right forearm |
Subcutaneous thickening, Fascial fluid Doppler shows reduced vascularization |
I.V. Antibiotics, Decompressive fasciotomy, and tissue debridement | Recovered | Caused by Loxosceles Rufescens spider bite |
| Magalhaes 2020 [23] | 54 | Nil | Linear probe | Left gluteal region |
Subcutaneous thickening Air Fascial fluid |
I.V. Antibiotics, surgical debridement | Recovered | Initial CT-Scan was not done due to logistic |
| Effron 2020 [24] | 32 | HIV, type I diabetes | N/A | Left medial ankle (Chronic ulcer from incision and drainage 45 days ago) |
Air Fascial fluid (extending from the wound up to the knee) |
I.V. Antibiotics Emergency surgical debridement and osteotomy of medial malleolus Knee amputation | Discharged to skilled nursing facilities. The amputation healed well | Group C Streptococcus, Proteus mirabilis Streptococcus mitis |
| Tung-Chen 2020 [25] | 68 | Low back pain | N/A | Left lower limb |
Subcutaneous thickening (cobblestone appearance) Fluid collection around the femur |
I.V. Antibiotics, Urgent surgery | Recovered | Streptococcus intermedius |
| Fozard 2020 [26] | 80 | Diabetes, hypertension | Linear probe | Left lower limb |
Subcutaneous thickening Superficial fascial fluid Anechoic pockets of fluid in the deep fascia |
I.V. Antibiotics emergency surgery Below knee amputation and extensive debridement | Patient passed away on day 4 |
Group A streptococcus CT-scan without contrast |
| Martinez 2020 [27] | 28 | Polysubstance abuse | N/A | Left lower extremity |
Subcutaneous thickening Air Fascial fluid |
I.V Antibiotics, surgical operation | N/A | – |
| Oelze 2013 (case series) [28] | 36 | Diabetes type 2, hypertension, and obesity | Linear probe | Left thigh |
Abscess Fascial thickening Fascial fluid Air |
I.V. Antibiotics, Wide local debridement | Recovered and discharged on day 11 | – |
| 58 | nil | Linear probe | Left lower leg |
Fascial thickening Fascial fluid Irregular fascial (extending proximally to the area without skin changes) |
I.V. Antibiotics, Left below knee amputation | Recovered and discharged after 10 weeks | Streptococcus pyogenes, Stenotrophomonas maltophilia | |
| 55 | Hypertension, chronic kidney disease, hepatitis C, polysubstance abuse, coronary artery disease, chronic obstructive pulmonary disease | Linear probe | Right hip to the anterior thigh |
Distorted edematous muscle Fascial fluid |
I.V. Antibiotics, Wide debridement | Transferred to long-term acute care facility for further rehabilitation | Necrotizing fasciitis was confirmed intraoperatively. Streptococcus pyrogen | |
| Shyy 2016 (case series) [29] | 47 | IV drug user | N/A | The left upper arm (after injecting heroin) |
Subcutaneous thickening Air Fascial fluids |
I.V. Antibiotics, surgical debridement | Discharged to the skilled nursing facility | Polymicrobial flora |
| 50 | N/A | N/A | Right thigh | Fascial fluids | I.V. Antibiotics, surgical debridement | Recovered and discharged on day 11 | Group A streptococcus |