Miss Directed. Weight Loss

DIAGNOSTIC TESTS FOR EVALUATION OF NECROTIZING SOFT TISSUE INFECTIONS- Laboratory tests are generally non-specific, and the leukocyte count may not be elevated. Elevations in creatine phophokinase can reflect tissue necrosis. Fat necrosis may lead to hypocalcemia.- Blood culture samples should always be collected, and they may reveal the causative pathogens in a significant number of cases.- Rapid bedside procedures that may assist in the diagnosis or management of necrotizing fasciitis include fine needle aspiration of the affected area, frozen section biopsy, measurements of muscle compartment pressure, and probing along a fascial plane via a limited incision to assess for pathologic loss of resistance.- Imaging of the affected area can aid in determining the extent of involvement. Plain radiographs may reveal soft tissue gas, particularly in cases of clostridal myonecrosis. However, gas may also be present in soft tissues secondary to a variety of traumatic and iatrogenic causes, and the absence of gas on any study cannot rule out clostridial myonecrosis. Computed tomography and magnetic resonance imaging show superior resolution of soft tissues. These studies may help distinguish necrotizing soft tissue infections from cellulitis. Computed tomography and magnetic resonance imaging may also evaluate the extent of infection, particularly in cases of cervical necrotizing fasciitis. Ultrasonography can be particularly useful in differentiating Fournier’s gangrene from other scrotal pathology. Nevertheless, waiting for imaging results should never delay surgical consultation in cases that raise strong suspicion of a necrotizing soft tissue infection.*124/348/5*