A 47-year-old male presented with progressive shoulder, neck, and chest pain accompanied by dysphagia, odynophagia, and hoarseness. He had several significant comorbid conditions reported in the source: poorly controlled diabetes mellitus, congestive heart failure, obesity, and a history of tobacco use. These comorbidities contributed to his high risk for invasive soft-tissue infection.
On admission his laboratory evaluation demonstrated marked leukocytosis and severe hyperglycemia. The combination of local symptoms in the cervicothoracic region, systemic inflammatory markers, and metabolic derangement raised early concern for a deep, rapidly progressive infection.
Computed tomography (CT) imaging played a central role in diagnosing the extent of infection. CT showed extensive subcutaneous emphysema originating at the sternoclavicular (SC) joint and extending into the anterior chest wall, mediastinum, and retropharyngeal space. These imaging findings were consistent with gas-forming or necrotizing soft-tissue infection tracking along fascial planes from the SC joint into deeper thoracic and cervical compartments.
The clinical and radiologic picture supported a diagnosis of cervicothoracic necrotizing fasciitis secondary to sternoclavicular septic arthritis. The source highlights the importance of early cross-sectional imaging when necrotizing infection is suspected, particularly in high-risk hosts or when symptoms progress rapidly.
The patient underwent emergent surgical exploration. Intraoperative findings confirmed necrotizing infection with involvement of the sternum, clavicular head, the sternocleidomastoid muscle, and the medial pectoralis muscle. These findings demonstrated both osseous and deep soft-tissue involvement originating from the SC joint.
Management required urgent and aggressive surgical debridement to remove necrotic tissue and control the source. The report documents serial operative debridements, indicating repeated procedures were necessary to manage ongoing infection and to achieve source control.
Following serial debridements, the patient received wound vacuum therapy (negative-pressure wound therapy) as part of local wound management. After infection control and local wound optimization, definitive chest wall reconstruction was performed using a pectoralis major muscle flap.
The staged approach—initial emergent debridement, repeated surgical washouts as indicated, wound vacuum therapy, and subsequent flap reconstruction—represents the surgical trajectory described in the case for restoring chest wall integrity after extensive tissue loss.
Successful infection control and reconstruction were achieved through coordinated care among multiple specialties. The case specifically notes involvement of otolaryngology, cardiothoracic surgery, infectious disease, and critical care teams. This multidisciplinary collaboration supported prompt operative management, appropriate perioperative critical care, targeted antimicrobial therapy (as implied by infectious disease involvement), and complex reconstructive planning.
The authors emphasize that cervicothoracic necrotizing fasciitis arising from SC septic arthritis demands early recognition and rapid escalation to operative management, with cross-disciplinary input to optimize survival and functional outcomes.
This case underscores several actionable clinical points reported by the source:
Maintain a low threshold to suspect necrotizing fasciitis in high-risk patients—particularly those with poorly controlled diabetes or other immunocompromising conditions—who present with severe neck or chest pain plus systemic toxicity.
Early imaging (CT) is critical to define the extent of disease, detect subcutaneous emphysema or gas tracking, and guide surgical planning.
Prompt surgical exploration and aggressive serial debridement are essential to control necrotizing infections that involve cervicothoracic fascial planes and adjacent osseous structures.
Local wound management with vacuum-assisted closure can be useful between debridements and before definitive reconstruction.
Multidisciplinary care—including otolaryngology, cardiothoracic surgery, infectious disease, and critical care—is important for source control, antimicrobial management, perioperative stabilization, and reconstructive planning.
The report concludes that survival and recovery in cervicothoracic necrotizing fasciitis depend on early diagnosis, prompt surgical intervention, and coordinated multidisciplinary management. The source does not provide details on specific antimicrobial regimens, timing of interventions beyond the sequence described, or long-term functional outcomes beyond the reconstruction event.