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Diagnosing necrotizing fasciitis: is there a difference between type I and type II with respect to computer
Dakarai Dunbar1, Sara Jain1, Lila Berle1
1The University of Maryland School of Medicine, Baltimore, MD, USA.
Infectious Diseases (London, England)
|July 11, 2026
Summary
Necrotising fasciitis (NF) diagnosis relies on clinical assessment, not just CT scans. Type I NF often shows gas on CT, unlike Type II NF, which is frequently missed by imaging.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotising fasciitis (NF) is a severe infection requiring prompt diagnosis.
- Computed tomography (CT) is often used to aid NF diagnosis.
- Type II NF, caused by non-gas-producing organisms, poses diagnostic challenges with imaging.
Purpose of the Study:
- To compare CT imaging findings between Type I and Type II Necrotising Fasciitis.
- To evaluate the utility of detecting gas on CT for differentiating NF types.
Main Methods:
- Retrospective review of 457 patient medical records with NF (2020-2024).
- Analysis of CT imaging reports and direct image review for the presence of gas.
- Comparison of imaging findings based on NF type and anatomical location.
Main Results:
- Gas was detected on CT in 75.5% of all NF cases.
- Type I NF showed significantly higher rates of soft tissue gas (91.8%) compared to Type II NF (7.8%).
- Significant differences in gas detection by CT were observed across all locations except the foot.
Conclusions:
- CT imaging demonstrating gas in soft tissues is not a reliable indicator for diagnosing Type II Necrotising Fasciitis.
- The absence of gas on CT scans does not rule out Necrotising Fasciitis.
- Necrotising fasciitis remains a clinical diagnosis, emphasizing the importance of clinical evaluation over imaging alone.
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