影像学诊断罕见发生于鼻咽部的颈部坏死性筋膜炎临床案例分析

邓侃; 徐慧; 陈玲玲; 龚玲燕; 李树平

doi:10.15953/j.ctta.2023.011

影像学诊断罕见发生于鼻咽部的颈部坏死性筋膜炎临床案例分析

doi: 10.15953/j.ctta.2023.011

海军军医大学中国人民解放军海军特色医学中心放射诊断科, 上海200052

详细信息

作者简介:
邓侃：男，海军军医大学研究生，主要从事肿瘤预后模型与AI分析的研究，E-mail：dkdkfjfj@aliyun.com

李树平：女，海军特色医学中心放射诊断科主任、副主任医师，研究方向为医学影像新技术的研究及应用以及分子影像学，E-mail：20739293@qq.com

通讯作者:
李树平∗，

中图分类号: R 814；R 445
计量
- 文章访问数: 64
- HTML全文浏览量: 25
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-04
- 修回日期: 2023-02-14
- 录用日期: 2023-02-14
- 网络出版日期: 2023-02-22
- 刊出日期: 2023-03-31

Imaging Diagnosis of a Rare Case of Cervical Necrotizing Fasciitis (CNF) in the Nasopharynx: A Clinical Case Analysis

Department of Radiology, Naval Medical Center of People's Liberation Army,Naval Medical University, Shanghai 200052, China

摘要

摘要: 本文介绍1例罕见的发生于鼻咽部的颈部坏死性筋膜炎（CNF）。该患者以顽固性慢性化脓性中耳炎就诊，进行包括CT、MRI及PET/CT在内的影像学检查，均误诊为鼻咽癌。最终该患者通过鼻咽肿物活检术确诊为CNF。本文通过回顾性分析该患者的影像学表现及误诊原因，总结出CT、MRI、PET/CT在CNF早期诊断中的特征和要点，为其临床精准诊断提供重要的帮助。
- PET/CT /
- 颈部 /
- 坏死性筋膜炎 /
- 放射学
Abstract: This case report describes a rare case of cervical necrotizing fasciitis (CNF) of the nasopharynx. The patient presented with intractable chronic suppurative otitis media and underwent radiological examination including CT, MRI, and PET/CT. All of the images misdiagnosed this condition as nasopharyngeal carcinoma. Finally, the patient underwent a nasopharyngeal mass biopsy and CNF was diagnosed. A retrospective analysis of the radiological scans was performed and the causes of the misdiagnosis were evaluated. The CT, MRI, and PET/CT characteristics and key features for the early diagnosis of CNF were summarized. Our findings may contribute to current knowledge of the precise diagnosis of CNF.
- PET/CT /
- neck /
- necrotizing fasciitis /
- radiology

HTML全文

图 1 CT图像及增强

Figure 1. CT plain and contrast enhanced images

下载: 全尺寸图片幻灯片

图 2 MRI图像及增强

Figure 2. MRI plain and contrast enhanced images

下载: 全尺寸图片幻灯片

图 3 PET/CT图像

Figure 3. PET/CT images

下载: 全尺寸图片幻灯片

参考文献(17)

[1]	BÖTTGER S, ZECHEL-GRAN S, SCHMERMUND D, et al. Odontogenic cervicofacial necrotizing fasciitis: Microbiological characterization and management of four clinical cases[J]. Pathogens, 2022, 11(1): 78. doi: 10.3390/pathogens11010078
[2]	MTENGA A A, KALYANYAMA B M, OWIBINGIRE S S, et al. Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam, Tanzania[J]. Bmc Infectious Diseases, 2019, 19(1): 642. doi: 10.1186/s12879-019-4267-x
[3]	ABDURRAZAQ T O, IBIKUNLE A A, BRAIMAH R O. Cervical necrotizing fasciitis: A potentially fatal disease with varied etiology[J]. Annals of Medical and Health Sciences Research, 2016, 6(4): 251−256. doi: 10.4103/amhsr.amhsr_33_16
[4]	CONGEDO M T, NACHIRA D, PENNISI M A, et al. Risk factors associated with post-operative complications in multidisciplinary treatment of descending necrotizing mediastinitis[J]. Journal of Clinical Medicine, 2022, 11(21): 6364. doi: 10.3390/jcm11216364
[5]	SUEHARA A B, GONÇALVES A J, ALCADIPANI F A, et al. Deep neck infection: analysis of 80 cases[J]. Brazilian Journal of Otorhinolaryngology, 2008, 74(2): 253−259. doi: 10.1016/S1808-8694(15)31097-1
[6]	CHOU P Y, HSIEH Y H, LIN C H. Necrotizing fasciitis of the entire head and neck: Literature review and case report[J]. Biomedical Journal, 2020, 43(1): 94−98. doi: 10.1016/j.bj.2019.08.002
[7]	NOUGUÉ H, LE MAHO A L, BOUDIAF M, et al. Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis[J]. Intensive Care Medicine, 2015, 41(7): 1256−1263. doi: 10.1007/s00134-015-3830-1
[8]	王家晨, 李春香, 王建明. 颈部坏死性筋膜炎的早期诊疗进展[J]. 中国眼耳鼻喉科杂志, 2021,21(1): 69−73. doi: 10.14166/j.issn.1671-2420.2021.01.019 WANG J C, LI C X, WANG J M. Progress in early diagnosis and treatment of cervical necrotizing fasciitis[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2021, 21(1): 69−73. (in Chinese). doi: 10.14166/j.issn.1671-2420.2021.01.019
[9]	WANG J M, LIM H K. Necrotizing fasciitis: Eight-year experience and literature review[J]. Brazilian Journal of Infectious Diseases, 2014, 18(2): 137−143. doi: 10.1016/j.bjid.2013.08.003
[10]	WONG C H, KHIN L W, HENG K S, et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections[J]. Critical Care Medicine, 2004, 32(7): 1535−1541. doi: 10.1097/01.CCM.0000129486.35458.7D
[11]	SARTELLI M, COCCOLINI F, KLUGER Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections[J]. World Journal of Emergency Surgery, 2022, 17(1): 3. doi: 10.1186/s13017-022-00406-2
[12]	KIM M C, KIM S, CHO E B, et al. Utility of magnetic resonance imaging for differentiating necrotizing fasciitis from severe cellulitis: A magnetic resonance indicator for necrotizing fasciitis (MRINEC) algorithm[J]. Journal of Clinical Medicine, 2020, 9(9): 3040. doi: 10.3390/jcm9093040
[13]	FERNANDO S M, TRAN A, CHENG W, et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: A systematic review and meta-analysis[J]. Annals of Surgery, 2019, 269(1): 58−65. doi: 10.1097/SLA.0000000000002774
[14]	MARTINEZ M, PEPONIS T, HAGE A, et al. The role of computed tomography in the diagnosis of necrotizing soft tissue infections[J]. World Journal of Surgery, 2018, 42(1): 82−87. doi: 10.1007/s00268-017-4145-x
[15]	KIM K T, KIM Y J, WON LEE J, et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging?[J]. Radiology, 2011, 259(3): 816-824.
[16]	ANDREASEN T J, GREEN S D, CHILDERS B J. Massive infectious soft-tissue injury: Diagnosis and management of necrotizing fasciitis and purpura fulminans[J]. Plastic and Reconstructive Surgery, 2001, 107(4): 1025−1035. doi: 10.1097/00006534-200104010-00019
[17]	KING A D, LEI K I, RICHARDS P S, et al. Non-Hodgkin's lymphoma of the nasopharynx: CT and MR imaging[J]. Clinical Radiology, 2003, 58(8): 621−625. doi: 10.1016/S0009-9260(03)00182-X