Necrotizing fasciitis or acute limb ischemia? Similarities and the diagnostic tactics

Abstract

The symptoms of necrotizing fasciitis (NF) and acute limb ischemia (ALI) are almost identical. We present a case of a 48-year-old male, who reported to the emergency room complaining of sudden severe pain in the right limb. The complaint was accompanied by blackish, water-filled lumps, and numbness. On examination, his femoral pulse was palpable but the pulse was weak in the common femoral artery (CFA), superficial femoral artery (SFA) and popliteal artery (POP A). No pulse was palpable in the posterior tibial artery (PTA), anterior tibial artery (ATA), and dorsalis pedis artery (DPA). SpO2 couldn’t be detected in first to fourth toes; it was 97% in the fifth toe. The laboratory investigations showed increased serum creatinine, so CT angiography could not be performed. Duplex Ultrasonography (DUS) was performed and showed triphasic morphology at the vascular level, while gas was seen in the subcutaneous tissues. Due to similar clinical appearances, it is difficult to differentiate the diagnosis of NF and ALI, while the treatments for both are very different. CT angiography, DUS examination and laboratory tests may be the first option to differentiate between the two conditions.