Diagnosis of necrotizing fasciitis in children

Hsun Chin Chao*, Man-Shang Kong, Tzou Yien Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

61 Scopus citations


Necrotizing fasciitis is a rare but progressive soft tissue infection. This condition is difficult to recognize in the early phase, when it is often confused with cellulitis. We report the cases of four children with necrotizing fasciitis. The initial presentation in these cases was cellulitis. Fever and soft tissue swelling occurred within 24 h and spreading erythema within 4 to 12 h. Radiologic studies of the lesions showed soft tissue thickening. Ultrasonography of the lesions demonstrated distorted, thickened fascia with fluid accumulation. Well-defined, loculated abscesses were demonstrated in two cases. Although typical dusky skin and purplish patches were not found in our cases, necrotizing fasciitis was strongly suspected on the basis of the clinical course and sonographic findings. Ultrasonography also was used as a guide for aspiration of pus. Gram-stained smears and bacterial cultures yielded the pathogens. The choice of antibiotic therapy was made on the results of smears and culture. All patients survived after immediate surgical debridement, intensive antibiotic therapy, and aggressive wound care. In conclusion, ultrasonography provides a rapid and valuable diagnostic modality for necrotizing fasciitis. The pus obtained through sonographically guided aspiration for bacterial culture can allow identification of the pathogenic organisms.

Original languageEnglish
Pages (from-to)277-281
Number of pages5
JournalJournal of Ultrasound in Medicine
Issue number4
StatePublished - 1999


  • Abscess
  • Fasciitis
  • Infection
  • Necrotizing
  • Necrotizing fasciitis
  • Soft tissue


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