The Role of FDG PET/CT in a Patient with Larynx Cancer Who Developed Necrotizing Fasciitis Secondary to Tracheostomy Which is a Rare Complication

Year 2017, Volume: 70 Issue: 1, 67 - 70, 21.04.2017

Ebru Bayar

https://doi.org/10.1501/Tipfak_0000000966

Abstract

Necrotizing fasciitis (NF) is characterized with rapid involvement of soft tissues and fascias and could be fatal
if not treated properly. Our patient had history of larynx cancer. He had a tracheostomy and developed NF of
the neck and upper mediastinum which is a very rare complication of tracheostomy.

The patient was referred for a Positron Emission Tomography/Computed Tomography (PET/CT) scan after suspicion
of residual lesion on follow up computed tomography (CT). On fluorodeoxyglucose (FDG) PET/CT images there was
moderate increased uptake at the anterior glottic region, in line with residual disease. PET/CT scan showed
progression of the NF involving the neck and upper mediastinum compared to the CT scan performed 10 days
before. On PET/CT a new pulmonary abscess was also noted in the lower lobe of the left lung.

In our case FDG PET/CT played an effective role in the follow up of oncologic disorders. It was also useful in
the follow up and treatment response of NF, which is a rare but potentially fatal infectious and inflammatory
disorder. Positron Emission Tomography/Computed Tomography (PET/CT) could be preferred in the follow
up of serious infectious conditions accompanying primary malignancy. 

Keywords

Necrotizing Fasciitis, 18F-FDG, PET / CT

References

• 1- Vayvada H, Demirdöver C, Menderes A, et al.Necrotizing fasciitis: diagnosis, treatment and review of the literature. Turkish Journal and Emergency Surgery 2012;18(6): 507-513.
• 2- Fichev G, Kostov V, Marina M, Tzankova M.Fornier’s gangrene: a clinical and bacteriological study. Anaerobe 1997;(3): 195-197.
• 3- Libanore M, Merlo R, Borin M, at al. Listeria Monocytogenes: an uncommon pathogen of cervical necrotizing fasciitis. B-ENT 2016;12(3): 245-247.
• 4- Stamenkovic I, Lew PD. Early recognition of potentially fatal necrotizing fasciitis. Theuse of frozen-section biopsy. N Engl J Med 1984;(310): 1689–1693.
• 5- Lee JW, Immerman SB, Morris LG. Techniques for early diagnosis and management of cervicofacial necrotising fasciitis. J Laryngol Otol 2010;(124): 759–764.
• 6- Edlich RF, Cross CL, Dahlstrom JJ, Long WB3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med 2010;(39): 261–265.
• 7- Fayad LM, Carrino JA, Fishmann EK.Musculoskeletal infection: role of CT in the emergency department. Radio Graphics 2007;(27): 1721–1735.
• 8- Fleming AJ, Jr, Johansen ME. The clinician’s expectations from the use of positron emission tomography/computed tomography scanning in untreated and treated head and neck cancer patients. Curr Opin Otolaryngol Head Neck Surg 2008;(16): 127–34.
• 9- Jamar, F.,Buscombe, J., Chiti, A et al.EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J NuclMed. 2013;(54): 647–658.
• 10 - Trent JT, Kirsner RS -"Necrotizing Fasciitis".Medscape 2002;11-21. 11- Turecki MB, Taljanovic MS, Stubbs AY, et al.Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010;(39): 957–971.
• 12- Kim KT, Kim YJ, Lee JW, et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology 2011 Jun; 259 (3):816–824.
• 13- Basu S, Torigian D, Alavi A. The role of modern molecular imaging techniques in gastroenterology. Gastroenterology 2008;(135): 1055-61.
• 14- Duncan BW, Adzick NS, deLorimier AA, et al. Necrotizing fasciitis in two children with acute lymphoblastic leukemia. J Pediatr Surg. 1992May; 27(5): 668-71.
• 15- Lou J, Low CH. Necrotising fasciitis in leukaemic children. Ann Acad Med Singapore.1990 Mar;19(2): 290-4.
• 16- Padma S, Sundaram PS, Shagos GS, Kumar S Unsuspected early necrotizing fasciitis identified by 18F-FDG PET imaging in a patient with acute myeloid leukemia. Iran J Nucl Med 2015;23(1): 53-55.