Objectives: Craniocervical necrotizing fasciitis (CCNF) is a rare life threatening soft tissue infection that results primarily in necrosis of fascial planes. The early stage of disease, clinically is similar to those of deep neck infections, which occur much more frequent. Radiologic findings are used to distinguish these two entities and early diagnose a CCNF.

Materials and methods: Contrast-enhanced CT scans from eight patients with surgically proved CCNF were compared to those of twelve patients with deep neck infections. CT features of CCNF and also deep neck abscess were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, (myositis); and fluid collections in multiple neck compartments. As a differentiation between the two entities, only a reticular enhancement of the subcutaneous fat was diagnosed significantly more frequent in CCNF.

Results: Characteristic radiological features of necrotizing fasciitis were also diagnosed in more common deep neck infections. The accurate determination of these different diseases in the early stage by contrast enhanced CT seems not to be possible.

Conflict of interest: None declared.