Necrotizing fasciitis on bedside ultrasound using STAFF criteria
Dr. Himanshu Gul Mirani
Nottingham University Hospitals, NHS Trust
Case Presentation:
54 yr old diabetic female with high BMI presented with complaints of swelling on the abdominal wall. It started with a boil which she burst a few days prior to presenting. On clinical examination, she was tachycardic with labile blood-pressure. Abdominal was warm to touch with local edema extending across the lower quadrants and left thigh which looked purpuric.
Necrotizing fasciitis on bedside ultrasound using STAFF criteria
Management and Outcome:
Ultrasound of the skin revealed sheets of hypoechoic fluid between tissue planes with several pockets of
abscesses. There was presence of air in the thickened subcutaneous tissue. Patient was taken for emergency surgery for extensive operative debridement and washout.
Key Learnings and Points:
Though ultrasound can’t be used to rule out necrotising fasciitis, it can be used to rule in the diagnosis. In this case necrotising fasciitis was rapidly diagnosed on bedside sonography using the STAFF criteria by demonstrating Subcutaneous Thickening, Air and Fascial Fluid.