CTICasesDescending Necrotizing Fasciitis with Osteomyelitis and Mediastinal Abscess
Imaging findings
In a diabetic patient with a preceding foot ulcer, bacteremia, and below-knee amputation who develops neck swelling, CT shows extensive gas and edema tracking along the platysma and sternocleidomastoid into the upper chest, with gas within the bone marrow of the clavicle and manubrium and an abscess in the prevascular mediastinum.
Key takeaways
Hematogenously seeded neck and chest wall infection can track along fascial planes to produce descending necrotizing fasciitis with direct extension into bone (producing intraosseous gas) and the mediastinum, illustrating that a distant source such as a diabetic foot ulcer can seed anatomically unrelated sites via bacteremia and require aggressive surgical debridement.
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