# Necrotizing fasciitis of the neck and emphysematous osteomyelitis of sternoclavicular joint: a rare case and peculiar imaging findings

## TL;DR

A rare case of severe neck infection and bone infection in the sternoclavicular joint is reported, emphasizing the need for early imaging to guide life-saving treatment.

## Contribution

The paper presents a rare clinical case with unique imaging findings that highlight diagnostic and management challenges.

## Key findings

- Contrast-enhanced CT revealed emphysematous osteomyelitis and necrotizing fasciitis not visible on plain radiography.
- Early cross-sectional imaging was critical for assessing severity and guiding surgical interventions.
- The case demonstrates the importance of radiology in diagnosing life-threatening soft tissue and bone infections.

## Abstract

Emphysematous osteomyelitis accompanied by necrotizing fasciitis (NF) is a rare life-threatening condition requiring immediate recognition and aggressive management. We report a case of a 47-year-old male who initially presented to the Emergency Department (ED) with fever, shoulder pain, and leukocytosis. The patient was discharged with analgesics for presumed musculoskeletal pain after an unremarkable chest radiograph. Over the following days, he developed a progressive chest and neck erythema, prompting his return to the ED. Bloodwork revealed a progression of leukocytosis. Contrast-enhanced CT identified emphysematous osteomyelitis of the first rib with sternoclavicular joint infection, accompanied by extensive NF of the upper mediastinum and lower neck, necessitating multiple emergent surgical interventions. This case underscores the importance of early cross-sectional imaging in suspected osseous and deep soft tissue infections, as plain radiography may appear deceptively normal. It also highlights the radiology’s pivotal role in assessing disease severity and guiding timely, potentially life-saving intervention.