---
title: "Cervicothoracic Necrotizing Fasciitis from Sternoclavicular Septic Arthritis: Case and Management"
id: "pubmed-42746804"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42746804"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42746804/"
doi: "10.1177/01455613261480434"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Cervicothoracic Necrotizing Fasciitis from Sternoclavicular Septic Arthritis: Case and Management
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42746804
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42746804/)
- **DOI:** [10.1177/01455613261480434](https://doi.org/10.1177%2F01455613261480434)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A 47-year-old man developed **necrotizing fasciitis** of the cervicothoracic region secondary to **sternoclavicular (SC) septic arthritis**. - Major comorbidities included poorly controlled **diabetes mellitus**, congestive heart failure, obesity, and tobacco use—factors that increase risk for severe soft-tissue infection. - Presenting symptoms were progressive shoulder, neck, and chest pain, plus dysphagia, odynophagia, and hoarseness, together with systemic signs. - Laboratory studies showed marked leukocytosis and severe hyperglycemia on admission. - Computed tomography revealed extensive subcutaneous emphysema tracking from the SC joint into the anterior chest wall, mediastinum, and retropharyngeal space, supporting a diagnosis of deep necrotizing infection. - Emergent surgical exploration confirmed necrotizing infection involving the sternum, clavicular head, sternocleidomastoid muscle, and medial pectoralis muscle. - Management required serial operative debridement, placement of wound vacuum therapy, and eventual chest wall reconstruction with a pectoralis major muscle flap. - Infection control and recovery were achieved through coordinated, multidisciplinary care involving **otolaryngology**, cardiothoracic surgery, infectious disease, and critical care teams. - The case emphasizes maintaining a low threshold to suspect necrotizing infection in high-risk patients with neck pain, severe clinical findings, and systemic symptoms, and the need for early imaging and prompt surgical intervention. - Keywords highlighted by the source: ENT surgery, deep neck infection, mediastinitis, necrotizing fasciitis, sternoclavicular septic arthritis.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Necrotizing Fasciitis of the Cervicothoracic Region Secondary to Sternoclavicular Septic Arthritis: A Case Report [Nishat A Momin](https://pubmed.ncbi.nlm.nih.gov/?term=Momin+NA&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#full-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA."), [Robert E Africa](https://pubmed.ncbi.nlm.nih.gov/?term=Africa+RE&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#full-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA."), [Hung P Phan](https://pubmed.ncbi.nlm.nih.gov/?term=Phan+HP&cauthor_id=42746804)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#full-view-affiliation-2 "John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA."), [Christina Rios](https://pubmed.ncbi.nlm.nih.gov/?term=Rios+C&cauthor_id=42746804)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#full-view-affiliation-2 "John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA."), [Orly M Coblens](https://pubmed.ncbi.nlm.nih.gov/?term=Coblens+OM&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#full-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.") Affiliations Expand ### Affiliations * 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA. * 2 John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA. * PMID: **42746804** * DOI: [ 10.1177/01455613261480434 ](https://doi.org/10.1177/01455613261480434) Item in Clipboard # Necrotizing Fasciitis of the Cervicothoracic Region Secondary to Sternoclavicular Septic Arthritis: A Case Report Nishat A Momin et al. Ear Nose Throat J. 2026. Show details Display options Display options Format Abstract PubMed PMID Ear Nose Throat J Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ear+Nose+Throat+J%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ear+Nose+Throat+J%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42746804/) . 2026 Sep 16:1455613261480434. doi: 10.1177/01455613261480434. Online ahead of print. ### Authors [Nishat A Momin](https://pubmed.ncbi.nlm.nih.gov/?term=Momin+NA&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#short-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA."), [Robert E Africa](https://pubmed.ncbi.nlm.nih.gov/?term=Africa+RE&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#short-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA."), [Hung P Phan](https://pubmed.ncbi.nlm.nih.gov/?term=Phan+HP&cauthor_id=42746804)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#short-view-affiliation-2 "John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA."), [Christina Rios](https://pubmed.ncbi.nlm.nih.gov/?term=Rios+C&cauthor_id=42746804)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#short-view-affiliation-2 "John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA."), [Orly M Coblens](https://pubmed.ncbi.nlm.nih.gov/?term=Coblens+OM&cauthor_id=42746804)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42746804/#short-view-affiliation-1 "Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.") ### Affiliations * 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA. * 2 John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA. * PMID: **42746804** * DOI: [ 10.1177/01455613261480434 ](https://doi.org/10.1177/01455613261480434) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Necrotizing fasciitis is a rare but potentially life-threatening infection requiring early recognition and immediate surgical management to prevent significant morbidity and mortality. We present a case of cervicothoracic necrotizing fasciitis arising from sternoclavicular (SC) septic arthritis requiring multidisciplinary management. A 47-year-old male with history of poorly controlled diabetes mellitus, congestive heart failure, obesity, and tobacco use presented with progressive shoulder, neck and chest pain, dysphagia, odynophagia, and hoarseness. Laboratory evaluation demonstrated marked leukocytosis and severe hyperglycemia. Computed tomography imaging demonstrated extensive subcutaneous emphysema extending from the SC joint into the anterior chest wall, mediatsinum and retropharyngeal space. He underwent emergent surgical exploration that confirmed necrotizing infection with involvement of the sternum, clavicular head, sternocleidomastoid muscle and medial pectoralis muscle. His hospital course required serial operative debridement, wound vacuum therapy, and eventual chest wall reconstruction with a pectoralis major muscle flap. Infection control was achieved through coordinated care involving otolaryngology, cardiothoracic surgery, infectious disease, and critical care teams. This case highlights the importance of maintaining a low suspicion threshold for necrotizing infections in high-risk patients presenting with neck pain, severe examination findings, and systemic symptoms. Early imaging, prompt surgery interventtion, and multidisciplinary management are essential for survival in cervicothoracic necrotizing fasciitis. **Keywords:** ENT surgery; case report; deep neck infection; mediastinitis; necrotizing fasciitis; sternoclavicular septic arthritis. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Necrotizing fasciitis of the neck and emphysematous osteomyelitis of sternoclavicular joint: a rare case and peculiar imaging findings. ](https://pubmed.ncbi.nlm.nih.gov/41624315/) Algodi M, Al Zubaidi A, Azizkhanian I, Al Jadiry H.Algodi M, et al.BJR Case Rep. 2026 Jan 19;12(1):uaag001. doi: 10.1093/bjrcr/uaag001. eCollection 2026 Jan.BJR Case Rep. 2026.PMID: 41624315Free PMC article. * [ Cervical Necrotizing Fasciitis, Diagnosis and Treatment of a Rare Life-Threatening Infection. ](https://pubmed.ncbi.nlm.nih.gov/33570428/) Hua J, Friedlander P.Hua J, et al.Ear Nose Throat J. 2023 Mar;102(3):NP109-NP113. doi: 10.1177/0145561321991341. Epub 2021 Feb 11.Ear Nose Throat J. 2023.PMID: 33570428 * [ Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. ](https://pubmed.ncbi.nlm.nih.gov/27015841/) Tanaka Y, Kato H, Shirai K, Nakajima Y, Yamada N, Okada H, Yoshida T, Toyoda I, Ogura S.Tanaka Y, et al.J Med Case Rep. 2016 Mar 26;10:69. doi: 10.1186/s13256-016-0856-0.J Med Case Rep. 2016.PMID: 27015841Free PMC article. * [ [Necrotizing fasciitis in the head and neck region-three case reports and a review of the literature]. ](https://pubmed.ncbi.nlm.nih.gov/32617608/) Huber L, Budjan J, Rotter N, Lammert A.Huber L, et al.HNO. 2020 Dec;68(12):935-943. doi: 10.1007/s00106-020-00899-w.HNO. 2020.PMID: 32617608Review.German. * [ Necrotizing fasciitis: a plea for early diagnosis and treatment. ](https://pubmed.ncbi.nlm.nih.gov/11514912/) Cunningham JD, Silver L, Rudikoff D.Cunningham JD, et al.Mt Sinai J Med. 2001 Sep-Oct;68(4-5):253-61.Mt Sinai J Med. 2001.PMID: 11514912Review. 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