Necrotizing fasciitis of the chest wall: A clinical case report and literature review

Petreanu,Cornel Adrian; Constantin,Traian; Iosifescu,Razvan; Gibu,Alexandru; Zariosu,Alexandru; Croitoru,Alina

doi:10.3892/etm.2021.11013

Necrotizing fasciitis of the chest wall: A clinical case report and literature review

Authors:
- Cornel Adrian Petreanu
- Traian Constantin
- Razvan Iosifescu
- Alexandru Gibu
- Alexandru Zariosu
- Alina Croitoru
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Affiliations: Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania, Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 061344 Bucharest, Romania, Department of General Surgery, ‘Sf. Ioan’ Clinical Emergency Hospital, 042122 Bucharest, Romania, Department of Pneumology, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
Published online on: November 26, 2021 https://doi.org/10.3892/etm.2021.11013
Article Number: 90
Copyright: © Petreanu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Necrotizing fasciitis of the chest wall is a very rare pathology, but with significant mortality, representing a therapeutic challenge. All international reports indicate the need for early diagnosis and an aggressive medical‑surgical attitude in order to improve the prognosis. In addition to a review of literature, we present a case developed secondary to a thoracic pleural drainage for pyopneumothorax associated with significant bronchopleural fistula in a destroyed tuberculous left lung. Along with medical treatment, extensive surgical debridement was required. Despite drainage incisions and negative pressure wound therapy (NPWT), the evolution of the fasciitis was difficult, due to bronchopleurocutaneous fistula. Thus, the Azorin procedure (transcervical mediastinoscopic closure of the left main bronchus) was performed. Once this procedure was completed, the inflammatory phenomena were controlled which allowed for a second step consisting of left pneumonectomy, with the application of specific methods for the prevention of bronchial fistula. The clinical case was a therapeutic challenge requiring a complex, staged, multidisciplinary approach due to both the immunocompromised terrain and the severity of the lesions. In conclusion, early recognition and aggressive and combined application of medical and surgical treatment methods can ensure therapeutic success.

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