J Korean Soc Radiol.  2019 Nov;80(6):1265-1270. 10.3348/jksr.2019.80.6.1265.

Idiopathic Primary Necrotizing Fasciitis of the Breast: A Case Report

• Won YJ
• Hwang JY
• Moon JH
• Ahn SK
• Yang I
• Woo JY

• KMID: 2464925
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1265

Abstract

Necrotizing fasciitis (NF) is a life-threatening infection characterized by extensive necrosis and inflammation of subcutaneous tissue and the fascia. Only a few cases of NF in the breast have been reported, and imaging findings of primary breast NF have not been described in the literature. As primary NF in the breast is extremely rare, it can be misdiagnosed as an abscess or cellulitis, and its diagnosis may be delayed. However, early diagnosis is crucial because delays can lead to fatal sepsis or requirement for total mastectomy. Herein, the authors report a rare case of primary breast NF that was diagnosed early using enhanced breast CT and successfully managed with local debridement. CT revealed a large cystic mass with an air-fluid level, a thickened deep fascia without remarkable enhancement, and extensive subcutaneous emphysema with subcutaneous fat infiltrations in the right breast.

MeSH Terms

Abscess
Breast*
Cellulitis
Debridement
Diagnosis
Early Diagnosis
Fascia
Fasciitis, Necrotizing*
Inflammation
Mastectomy, Simple
Necrosis
Sepsis
Subcutaneous Emphysema
Subcutaneous Fat
Subcutaneous Tissue

Figure

• 

  Fig. 1 A 53-year-old female with primary breast necrotizing fasciitis. A. Initial gross photograph revealing skin color change and swelling in the right breast. B. Chest radiograph reveals no remarkable focal lung lesion, but diffuse subcutaneous emphysema is present in the right chest wall and neck. C. Breast ultrasonography revealing echogenic lines with dirty posterior shadowing suggesting air collection (arrows). D. Contrast-enhanced breast computed tomography revealing a large complex cystic mass with air-fluid level in the right breast. Combined subcutaneous emphysema with fat infiltration is also apparent. There is deep fascia thickening but no demonstrable enhancement of the deep fascia. E. Operation field photograph revealing necrosis of the deep fascia. F. Excisional biopsy revealing an extensive acute inflammatory reaction with extensive fascial necrosis (left), gas-inclusion (arrow), and fat necrosis (right). The findings are compatible with necrotizing fasciitis. H&E = hematoxylin and eosin

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